Acute Care

Amputation Surgery

Acute Transtibial Stump

Causes of amputation include:

  • Vascular insuffuciency
  • Trauma
  • Cancer
  • Congenital deformity
  • Orthopaedic - removal of painful joints or correction of deformity
  • Pain Management
  • Infection

Amputations can be classed as relatively minor, such as the removal of a digit, or partial hand or foot, or major, which is classed as from above tarsometatarsal joints (in the lower limb) right up to amputations of an entire limb or segments of the torso. Factors influencing the level of selection for the amputation vary significantly, and include:

  • The level to which there remains enough blood supply to allow wound healing and viability of the residual limb, preserving as many joints as possible. Diseased or gangrenous tissue must be removed as much as possible, if not all.
  • The severity of soft tissue disease or damage, and the ability to reconstruct the bone and soft tissue
  • The severity of soft tissue deformity
  • Considerations around patient comfort levels versus the potential functional outcome, for example bed bound patients
  • Clinical judgement of the surgical team, based on examination of skin, pulses, and results of tests of blood flow
  • The degree to which life is threatened by the decision not to amputate
  • Prosthetic considerations: ability to provide a well formed stump, with a reasonable lever arm, without leaving a residual limb too long such that it precludes use of some prosthetic components

The information here is far from exhaustive on the factors influencing amputation surgery. More information, including articles and videos can be found at There are also videos on YouTube, including less graphic animated instructional videos.


  • Clyne CA (1991). Selection of level for lower limb amputation in patients with severe peripheral vascular disease. Ann R Coll Surg Engl. May; 73(3): 148–151
  • Michaels JA (1991). The selection of amputation level: An approach using decision analysis. Eur J Vasc Surg, Aug. 5,(4): 451–457
  • Sarin S, Shami S, Shields DA, Scurr JH, Smith PD (1991). Selection of amputation level: a review. Eur J Vasc Surg. Dec. 5(6): 611-20
  • The Amputation Surgery Education Center