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Lower limb amputations

Despite all of our efforts to prevent amputations from happening, we will never be able to prevent all of them. In low-resource areas, we usually observe significant patient delays, especially concerning chronic wounds, which significantly increase the risk of amputation. The decision to amputate a foot can, at times, be easy when it is a life-saving procedure in a patient with a severe infection. At other times, we may feel that we have failed the patient. This is a sensitive and complex topic because it is highly multifactorial.

In this chapter, we will focus on amputations in the lower limb secondary to wounds, ischemia, and infection, which are most commonly encountered in chronic wound care. The largest risk factors are peripheral arterial disease (PAD) and diabetes mellitus. However, the amputation techniques described here also apply to acute traumatic injuries.

In the following chapters, we present how we, the editors of WoundsAfrica, deal with these types of amputations. We respect that some of you will have other opinions on approaching these amputations. After reviewing the available literature, you will be aware that there is a fair amount of discussion in the medical community about amputations, and we lack a definite consensus on several aspects of this type of surgery. One thing we all agree on is that the amputation will fail if you try to adapt the skin flaps together under tension!

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Key aspects of lower limb amputations

What are the indications for amputations? What are the primary considerations when deciding on the level of an amputation? What can we improve before we go through with the surgery? We recommend that you read this chapter first - we are sure that you will find a few pearls that may be useful to you. credit: ranplett/istock

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Lower limb amputation techniques

In this chapter, we provide you with tips and tricks for forefoot, midfoot, below-knee, and above-knee amputations. If you do not perform these surgeries often, this chapter will likely be helpful. Credit: Husky Orthopedics/Youtube

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Prosthesis fitting and rehabilitation

Even in relatively remote areas with low resources, amputees can usually be fitted with prostheses, often through charities and other organizations. In several regions of Africa, well-established training courses for prosthetic engineers exist. 

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