Amputation

An amputation is an operation to remove all or part of a limb. This type of surgery is sometimes used to treat primary bone cancer or soft tissue sarcoma in an arm or leg.

It is usually possible to remove a cancer in an arm or leg without having to remove the whole limb. This is called limb-sparing surgery.

Rarely, the surgeons may need to remove (amputate) all or part of a limb.

They may suggest this if:

• the cancer has spread from the bone into the surrounding blood vessels
• your movement will be better after an amputation than after limb-sparing surgery
• you get an infection in the bone after limb-sparing surgery that does not respond to treatment
• the cancer comes back in the bone.

After talking to your doctor, family or friends, you may choose to have an amputation instead of limb-sparing surgery.

When you wake up from the operation, you will usually have a drip (intravenous infusion) to keep you hydrated. This can be removed as soon as you are drinking enough.

To start with, the area operated on will be bandaged. You will have a tube in the wound to drain any fluid that builds up. This is removed when fluid has stopped draining. This usually takes a few days.

When the bandages have been removed, your physiotherapist or nurse will fit a compression garment. This helps reduce swelling. You will also be given advice about looking after the scar.

Pain can usually be controlled effectively with painkillers. They may be given:

• into a vein (intravenously)
• into the space around the spinal cord (epidural)
• into a muscle (intramuscularly)
• as tablets.

If you are in pain, let your nurses and doctors know as soon as possible. This will help them give you the right amount of painkillers.

Some people have pain that feels like it is coming from the part of the limb that has been amputated. This is called phantom pain or phantom sensation. This pain usually fades over time, but there may be some discomfort in the area for a while after the operation. If you have any phantom pain, let your nurses and cancer doctor know. They can give you drugs to help control it, such as pregabalin or gabapentin.

A physiotherapist or occupational therapist (OT) will help you get up. This often happens on the first or second day after the operation. It might be hard at first, and you will need to start slowly.

If you have had an arm amputated, you will be able to get up and move around once your pain is controlled and you have recovered from the anaesthetic.

If you have had a leg removed, the physiotherapist will show you how to move around in bed and how to get into a chair. To start with, you will use a wheelchair.

The OT will arrange a wheelchair for you to use in the hospital. You may need the wheelchair at home while you get used to moving around using crutches or an artificial limb. Before you go home, you will be referred to your local wheelchair service. You will also be given advice about using a wheelchair at home.

Your nurses or physiotherapist will teach you breathing and leg exercises. The exercises will help prevent you getting a chest infection and blood clots. Chest infections or blood clots can develop if you are not moving around as much as normal. You can help your recovery by doing the exercises as often as you need to.

You may be given elastic stockings called TED stockings to wear to help prevent a blood clot in your leg. This is called a deep vein thrombosis or DVT. You may also be given injections of anti-clotting medicines to help thin your blood.

When you are moving around more, you will go to the hospital gym for physiotherapy. This is a very important part of your recovery. Your physiotherapist will give you exercises to do as the wound heals and you gain strength. They will show you how to keep the muscles around the amputated limb strong and supple. This will make it easier to work an artificial limb if you have one.

Your physiotherapist will arrange for you to keep having physiotherapy when you go home. This will usually be as an outpatient and can often be near your home.

Amputation is a major operation, and rehabilitation can take a long time. It can be hard work and may be frustrating at times.

After the amputation, the occupational therapist (OT) will help you manage day-to-day activities, such as washing, dressing and using the toilet. They can also recommend equipment to help you be as independent as possible.

If you have had an arm amputated, your OT may teach you ways to reduce swelling. They will also teach you how to do some activities with 1 hand.

The OT can also give you advice about driving, work and getting back to social activities. They will help you think about how your amputation may affect your life and look at different ways to manage it.

If you have had a limb removed, you must tell your car insurance company and the:

• DVLA in England, Scotland or Wales
• DVA in Northern Ireland.

Changes can be made to your car to help you drive. Your OT can tell you more about them, and suggest organisations that can make the changes you need.

This scheme allows people with mobility problems to park closer to where they want to go. Gov.uk has more information about the Blue Badge scheme and how to apply. Or you can contact your local council for more information. A healthcare professional, welfare rights adviser or social worker can help with the application.

Amputation can be very distressing and can take a long time to come to terms with.

Losing an arm or a leg can feel like a bereavement. You will need time to grieve for your loss and start coping with the emotional and practical problems this type of surgery can bring.

We have more information about dealing with the emotional effects of cancer.

You may feel shocked and distressed after the operation. You are used to what your body looks like, and it can be very hard to come to terms with a major change such as an amputation.

Feeling that you look different from other people can affect your confidence and how you think and feel about your body (body image). At first, you may find it hard to see people after your amputation. But you and the people close to you will get used to the way you look. This will help you become more confident about dealing with the reactions of people you do not know.

Some people find it helpful to move around as soon as possible after their operation. But it is important to take the time you need after surgery to adapt and do things in your own time. You may want to take someone with you when you first go out, to give you emotional support. You may find other people do not even notice your amputation, especially if you are wearing an artificial limb.

Some people might find it helpful to talk with a psychologist or counsellor. Your doctor or nurse can arrange this for you.

We have more information to help you cope with body changes.

Your family and friends may also find it hard to manage their feelings about your amputation. You may be anxious about what they will say or think, and if you will be able to cope with their reactions. But most people find their family and friends want to do as much as possible to support them. It can help to talk about your feelings and any worries you have.

Some people may feel unattractive and embarrassed about their body. If you have a partner, you may be worried they will not find you attractive. Meeting a new partner may seem scary. We have more information about cancer and your sex life.

Help is available

You will need time and help to come to terms with your emotions, which are likely to be very strong. The hospital staff will know this and will help you as much as they can. Many people find it helpful to discuss their feelings with a close friend or someone who is removed from their situation, such as a counsellor. Often, there are counsellors or psychologists in the hospital, and the staff can arrange for you to see them.

Our cancer support specialists can talk to you, and tell you how to contact a counsellor or local cancer support group. You can call them on 0808 808 00 00.

There are also different organisations that offer support, such as the Limbless Association.