Amputation

My father

02/18/2008 03:57PM

Question:

My father is a paraplegic (x20+yrs) he is not a diabetic and has already had his left leg amputated below the knee results from ulcers. Now he has fallen out of his chaie and fractured his right fibula and created a good 4" cut along the fracture site not only did he keep this from his family but kept the bleeding a secret until we realized something was wrong 3 days later. Now he has a very purple leg and a horrible infection, he is currently under antibiotic treatment and awaiting to see a surgeon. He livess in a rural community and the local hospital there is not equiped to handle a situation like his, we are on a waiting list at a local university to be admitted. My question is how will a possible amputation on this leg affect his mobility and what happens if gangrene sets in?

Answer:

Hopefully your father's right leg infection will be controlled such that he won't need to undergo another amputation. If gangrene sets in, the possible need for amputation will depend on:

the level and extent of tissue involved

its response to antibiotic treatment and other wound care (such as hyperbaric oxygen therapy)

whether arterial bypass surgery would be indicated

among others.

If your father is completely paralyzed (that is, no active movement of his legs), and if he ultimately needs to undergo amputation of his right leg, he wouldn't need a right leg prosthesis from a mobility standpoint. If he has a "cosmetic" prosthesis for his left leg, he may then also want a cosmetic prosthesis for his right leg.

If he undergoes amputation of his right leg, and if he doesn't use prostheses, his body's center of gravity while sitting in his wheelchair will change, such that he may be more at risk for tipping backward (if he uses a standard manual wheelchair), in which case either wheelchair modification or replacement (the axle of the drive/rear wheels would need to be positioned a bit further backward) may be necessary.

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Response by:

Brian L. Bowyer, MD
Associate Professor of Clinical PM&R
OSU Sports Medicine and Family Health Center
Department of Physical Medicine and Rehabilitation
College of Medicine
The Ohio State University