Amputation Care

Amputation is a treatment endpoint, not a single disease. Lower-limb amputation, particularly dysvascular and diabetes-related limb loss, while also addressing traumatic hemorrhage and amputated-part preservation. The common diabetes-related pathway is cumulative: neuropathy removes protective pain, peripheral artery disease limits oxygen delivery and healing, and repetitive plantar pressure acting on deformity produces an ulcer. Infection or ischemia can then destroy tissue. A painless ulcer is therefore not reassuring; it may be the visible point of a limb-threatening process. A hot, swollen, erythematous neuropathic foot without an ulcer is a different pattern that should raise acute Charcot neuro-osteoarthropathy as well as cellulitis. Missing Charcot allows continued loading to produce collapse, deformity, ulceration, and eventual amputation. Chronic limb-threatening ischemia (CLTI)—ischemic rest pain, ulceration, and/or gangrene attributable to peripheral artery disease—carries both limb and cardiovascular danger: the approximate one-year amputation risk is 15–20%, and one-year mortality is 15–40%. It is not a problem confined to the foot. Multispecialty evaluation for revascularization is recommended before primary amputation, regardless of WIfI stage, because endovascular, surgical, or hybrid treatment may prevent limb loss or permit a more...