Amputation Care

The clinician managing amputation patients makes critical decisions regarding amputation level, perioperative optimization, and long-term outcome maximization. Amputation level selection balances healing potential against functional outcome. For dysvascular amputations, predictive factors for healing include: TcPO2 (above 40 mmHg = 90% healing rate, 20-40 mmHg = 50%, below 20 mmHg = less than 30%), ABI (above 0.5 at BKA level suggests adequate perfusion), skin perfusion pressure (SPP above 30 mmHg predicts healing), and clinical assessment (capillary refill, tissue viability, presence of granulation tissue). The BKA-to-AKA ratio is a quality metric for vascular surgery programs: higher ratios indicate more limb-preserving approaches with adequate healing. Perioperative mortality for major lower extremity amputation is significant: 30-day mortality 4-22%, 1-year mortality 30-50% for AKA and 10-30% for BKA, primarily from cardiovascular disease. Perioperative optimization includes cardiac risk assessment (many amputation patients have severe coronary disease), glycemic control (target glucose 140-180 mg/dL perioperatively), nutritional optimization (albumin above 3.0, prealbumin above 15 mg/dL), and VTE prophylaxis. The clinician prescribes the rehabilitation program, determines prosthetic candidacy and prescription, manages chronic phantom limb pain, and coordinates the interdisciplinary care...