A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.
An amputation below the knee may be done because of: Poor blood flow that cannot be fixedTumorsTrauma
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Poor healing of the amputation site that may require a higher level amputationSkin breakdown at the residual limbInfectionDecreased range of motion in the hip or kneePhantom sensation
—feeling that the amputated limb is still there
—feeling pain in the amputation area
Stump swellingBleedingReaction to anesthesiaHeart attackBlood clots
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinking
Chronic diseases, such as
Your doctor may do the following before your procedure: Physical examBlood tests
Imaging tests, such as
Have you donate blood in case you need a transfusionPrescribe antibiotics to prevent infection
Before surgery, you will need to: Arrange for a ride home.Arrange for help at home while you recover.Talk to your doctor about any medications, herbs, or supplements you are taking.
Ask your doctor about devices you will need after the surgery, such as an artificial limb,
You may need to stop taking some medications up to one week before the procedure. Medications that may need to be stopped may include: Anti-inflammatory drugsBlood thinnersAntiplatelets
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
The doctor will make a cut in the skin below the knee. The muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days. A dressing and compression stocking will be placed over the stump.
A cut is made below the knee.
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Several hours, depending on your health and the reason for the surgery
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
The usual length of stay is 5-14 days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include: Pain medicationsAntibiotics to prevent infectionMedication to prevent blood clots
Physical therapy often starts within 24 hours after your surgery. During this time you may need devices to help you walk.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision
When you return home, take these steps: Follow your doctor’s instructions on cleaning the incision site.Ask your doctor when it is safe to shower, bathe, or soak in water.Continue with your physical therapist’s exercise program.
Adjusting to an amputation may be difficult and can lead to
. Consider talking to a therapist or psychologist.
Call your doctor if any of these occur: Increased swelling in the residual limbPoorly fitting prosthesisPain that can't be controlled with the medication you've been givenSigns of infection, such as fever or chillsIncreasing redness, swelling, increasing pain, excess bleeding, or discharge from the incision sitePersistent nausea or vomitingIncreased symptoms of depression
New or persistent
, shortness of breath, or chest pain
Joint pain, fatigue, stiffness, rash, or other new symptoms
If you think you have an emergency, call for medical help right away.
Amputation. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical_medicine_and_rehabilitation/amputation_85,P01141. Accessed December 3, 2013.
Amputation. Society for Vascular Surgery website. Available at:
http://www.vascularweb.org/vascularhealth/Pages/amputation.aspx. Updated February 2011. Accessed December 3, 2013.
Amputation procedure. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/amputation_procedure_92,P08292. Accessed December 3, 2013.
Management of critical limb ischemia. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 2, 2013. Accessed December 3, 2013.
Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Last reviewed December 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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