Preoperative care

The following points should be recognized:

• Admission to hospital is always an anxious time, especially for patients fearing or facing a major amputation

• When patients are worried and anxious they may not retain information

• Information should be repeated several times and reinforced with the written word

• Patients like to feel that their limb is valuable, and that initial investigations and interventions are made in an effort to try and save the limb

• Patients want to know the reason why the leg needs to be amputated

• If patients are ill and toxic they may not comprehend what is happening

• Patients who are facing amputation should be given time to come to terms with it wherever possible

• Detailed explanations of all procedures should be given. The level of amputation should be explained and the intended site of amputation should be touched with the health-care professional's hand to demonstrate the level. The patient should be told that the wound will be covered with skin

• The effects of a general anaesthetic should be explained to the patient and family

• The stress of amputation should not be underestimated. If the operation is delayed or cancelled for any reason the patient and relatives should be informed immediately.

Physical assessment of the patient is important.

Cardiorespiratory status and metabolic control should be optimized. Patients should be encouraged to cease smoking. Malnutrition increases the risk of delayed wound healing. Weight loss and diminished appetite are common and patients should be seen by the dietitian. Antibiotic prophylaxis should be used. Once major amputation is planned a lumbar epidural block with bupivicaine can be started 48 h beforehand to relieve postoperative pain.

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