How amputations are carried out
There are numerous ways that amputations can be carried out, depending on the specific limb that needs to be removed and how much of the limb can be saved.
An amputation can be "minor" (where only a toe, finger or part of the foot or hand is removed), or "major" (where a large part of the limb is removed).
Lower limb amputations
In the UK, most amputations are carried out on the feet and legs, and the various types include:
Amputations above the ankle
- transtibial (below-knee) amputation – where the bottom section of a leg is amputated beneath the knee
- knee disarticulation or through knee amputation – where the amputation is performed through the middle of the knee joint
- transfemoral amputation – where both the bottom half of the leg and part of the thigh above the knee are amputated; also known as an above-knee amputation
- double lower amputation – where both legs are amputated, usually below the knee
- hip disarticulation – where the amputation takes place through the hip joint, removing the entire leg
- lower digit amputation – where one or more of the toes are amputated
Amputations below the ankle
- transmetatarsal or forefoot amputation – where the toes and forefoot are amputated
- digit amputation – where one or more toes are amputated
Upper limb amputations
Most upper limb amputations are needed because the hand and arm have been severely injured. The main types of upper limb amputation performed in the UK are:
- finger or digit amputation – where the thumb or one or more of the fingers are amputated
- transhumeral amputation – where the hand and a section of the arm are amputated above the elbow
- transradial amputation – where the hand and a section of the arm are amputated below the elbow
- wrist disarticulation – where the amputation occurs through the wrist joint, removing the hand
- elbow disarticulation – where the amputation occurs through the elbow joint, removing the hand, wrist and forearm
Unless your amputation is performed as an emergency, you'll be fully assessed before surgery, to find the most suitable type of amputation and identify anything that may affect your rehabilitation.
This assessment may include:
- a thorough medical examination – including assessing your physical condition, nutritional status, bowel and bladder function, and the various systems of your body, such as your cardiovascular system (heart, blood and blood vessels) and your respiratory system (lungs and airways)
- an assessment of the condition and function of the healthy limb – removing one limb can place extra strain on the remaining limb, so it's important to reduce any potential risk of amputation of the remaining limb at a later date
- a psychological assessment – to determine how well you will cope with the psychological and emotional impact of amputation, and whether you will require additional support
- an assessment of your home, work and social environments – to determine whether any additional provisions will need to be made to help you cope
After the assessment, your surgeon can advise you on the type of amputation you need.
You will also be introduced to a physiotherapist, who will be involved in your post-operative care and, if necessary, a prosthetist (a specialist in prosthetic limbs) who will tell you more about the type and function of prosthetic limbs (or other devices) available.
Factors that will influence the type of prosthetic limb recommended for you include:
- the type of amputation
- the amount of muscle strength in the remaining section of the limb
- your general state of health
- tasks the prosthetic limb will be expected to perform, such as whether you have a desk or manual job, and what type of hobbies you have
- whether you want the limb to look as real as possible or whether you're more concerned with having a prosthesis which allows the widest range of activities
Although it's possible to have a prosthetic limb that is both physically realistic and functional, there may have to be an element of compromise between the two.
Many people planning to have an amputation find it both reassuring and useful to talk to somebody who has gone through a similar type of amputation. A member of your care team may be able to put you in touch with someone.
An amputation is carried out under a general anaesthetic (where you are asleep) or an epidural anaesthetic (where a spinal injection is used to numb a certain area of your body), so you will feel no pain during surgery.
The length of the remaining limb will be determined by the ability of the tissues to heal and to retain optimum function.
Once the treated limb has been removed, a number of additional techniques can be used to help improve the remaining limb function and reduce the risk of complications.
These include shortening and smoothing the bone in your remaining limb so it is covered by an adequate amount of soft tissue and muscle, and stitching the remaining muscle to the bones to help strengthen your remaining limb.
After the amputation, the remaining stump wound is sealed with stitches or surgical staples.
Read more about recovering after an amputation.
Your care team
Carrying out an amputation and then helping the person adjust to life afterwards requires a team of different health professionals, each with their own speciality. These sorts of teams are known as multidisciplinary teams (MDTs).
Members of your MDT may include:
- a surgeon and anaesthetist
- a specialist nurse
- a physiotherapist (therapist who can help improve range of movement and co-ordination)
- an occupational therapist (therapist who can help improve the skills and abilities needed for daily activities, such as washing or dressing)
- a prosthetist (specialist in prosthetic limbs)
- a psychologist (health professional who specialises in mental health)
- a social worker
- a dietitian (specialist in diet and nutrition)
Page last reviewed: 21/07/2014
Next review due: 21/07/2016