Key points

• Peripheral vascular disease is the leading cause of amputation in the Western world

• Diabetics are 8–12 times more likely to suffer amputation

• Mortality and subsequent loss of the contralateral limb following amputation is high

• The level of amputation requires careful consideration of the rehabilitative potential of the patient, level and pattern of vascular disease and likely healing

• Careful preoperative assessment and periopertive care using the multidiscliplinary team is essential for successful outcomes

• Epidural analgesia provides the best perioperative analgesia but does not prevent subsequent phantom pain

• The general principles of amputation surgery apply to all sites of amputation

• Rehabilitation of the patient should start immediately postoperatively

• Postamputation pain is the commonest postoperative complication, is multifactorial and requires thorough assessment and possible onwards referral to a multidisciplinary pain team for management

• Phantom limb pain is common and effective treatments remain elusive

History of amputation

Amputation, derived from the latin amputare, ‘to cut away’, is one of the oldest surgical operations. The first recorded amputation appears in the book of the Vedas, written in Sanskrit in India, dated between 3500 and 1800 BC. It records that the leg of Queen Vishpla was amputated in battle, and after healing, an iron leg was fitted to enable the Queen to return to the battlefield.

The early descriptions of amputation by Hippocrates and Celsus focused on amputation for the treatment of gangrene.