Major amputations of the lower extremities Practical instructions and recommendations

The indications for a major amputation of the lower extremities in vascular surgery patients often arise from a lack of reconstructive options in cases of peripheral arterial occlusive disease or diabetic foot syndrome with an ascending infection. Amputations should be planned in a multidisciplinary approach, considering both clinical and radiological findings alongside the patient's individual goals of the prosthetic rehabilitation, whereby an amputation as distal as possible is fundamentally strived for. A comprehensive preoperative preparation is essential particularly for multimorbid patients to reduce postoperative complications. This includes preoperative antibiotic prophylaxis to prevent infections, an interdisciplinary pain management concept and psychological support. The intraoperative selection of the incision site in a noninfected, well-perfused area, careful handling of nerve stumps and ensuring a tension-free skin closure are essential to minimize pain and wound healing disorders. A comprehensive postoperative aftercare is necessary which includes multimodal pain treatment, the fitting and use of an interim prosthesis and intensive rehabilitation. The rehabilitation should be carried out in a specialized clinic to optimize mobility and adjustment of the prosthesis. The accompanying physiotherapy and outpatient walking training ensure long-term mobility, whereas the psychological support sustainably promotes the quality of life and adjustment to the new life situation.