You Don't Have to Lose Your Leg!
An interview with Scott Westfall, MD, FACS, Certified Vascular Surgeon

Note to our readers: First and foremost, you should know that a problem in the foot or leg does NOT mean you will lose your leg. Specialists will try everything they can to save your leg. In this interview for Keeping In Circulation, Dr. Westfall encourages people to seek help early and save their legs!

VDF: Dr. Westfall, why do people with vascular diseases have a limb amputated?

Dr. Westfall: There are several medical reasons for a major leg amputation (below or above the knee). The most common reasons for amputations are extensive tissue destruction or severe infections in the foot that won't heal, which means the foot cannot be repaired. In a very few patients, there may be too much deformity in the foot, or the leg may not be functional due to previous injury, and amputation is the only thing that will allow the patient to return to functional life. The number one risk is diabetes.

VDF: Is amputation always the last resort or are there other treatments?

Dr. Westfall: Amputation is always the last resort. Before considering amputation, physicians will consider some other treatment. More time is spent trying to save a leg than is ever given to the thought of amputation. Typically the patient comes in first with a problem such as an ulcer on the foot or toe, or even gangrene in a toe. The doctor or health care provider will perform a physical exam and then several blood flow studies to determine if there is enough blood supply to heal the foot or toe. These studies may include ultrasound examinations, Ankle-Brachial Index and segmental pressures. If there is a problem with circulation, then an arteriogram (x-ray using dye) is done to help decide which procedure will improve the circulation. Procedures considered may include stents, angioplasty in the leg arteries, or a bypass graft to the ankle or foot.

If the patient comes in with problems such as an infected leg or foot, antibiotics are given and the area may be cleaned up (debrided). In rare cases, a hyperbaric chamber (an enclosed container or room into which extra oxygen is pumped) is used to get enough oxygen to help the body heal the infected area.

In addition, other conditions that the patient has, such as diabetes or heart disease, are also treated to improve the chances of healing. Getting diabetes under control is very important, and tuning up the heart helps blood flow more easily to the entire body as well as to the legs for healing.

VDF: Does a patient's age play a part in the decision to amputate?

Dr. Westfall: No, age does not play a part in the decision to amputate. Instead the focus is on mobility. If the person is up and around, more time and effort is spent in trying to save a leg than if he or she is confined to a bed or a wheelchair and not able to exercise or use the leg.

VDF: What happens when the only option is amputation?

Dr. Westfall: Once all other options are exhausted, the only option remaining is amputation. In some cases, amputation may prevent further spreading of the infection that could eventually put the person's life at risk. In most cases, amputation will eliminate the incredible pain the person has been enduring.

After an amputation, patients are usually in the hospital between five to seven days, mostly for pain control. Besides the surgery pain, the patient may experience what is known as "phantom pain". This is the feeling that there is still pain in the lost leg and may take some time to go away. In some hospitals, a cast may be applied to the amputation site immediately or an artificial leg (prosthesis) put on. Other hospitals may use an elastic wrap or an elastic stocking to keep the swelling down and make the stump ready for a permanent prosthesis. It takes about one month for the leg to heal enough to be fitted for prosthesis.

VDF: What about rehabilitation?

Dr. Westfall: Following discharge from the hospital, the patient may go to a rehabilitation unit or a skilled nursing facility. This depends on how strong the patient is and whether other medical conditions are under control. Rehabilitation for a below-knee amputation is much easier than it is for an above-the-knee amputation. That is why the doctors always work very hard to save the knee. An above-the-knee amputation does not allow the muscles to work as efficiently in relearning to walk.

VDF: Do you have any advice to our readers, which might prevent an amputation?

Dr. Westfall: Definitely. My best advice to help prevent an amputation is to stop smoking (or never start) and keep your cholesterol and blood pressure under control. If you have diabetes, manage it carefully, check your blood sugar often, and see your health care provider regularly. If you know you have diabetes or hardening of the arteries in your leg, you need to know you are at a higher risk for foot ulcers and infection. The way to help prevent ulcers or infection is to practice good foot care and hygiene.

Most important, don't wait or ignore any signs of trouble, thinking they are too trivial, will go away or get better. The earlier you see your doctor about foot and leg problems, the easier the treatments and less serious the consequences. With good care and attention, you can keep both legs!

Dr. Scott G. Westfall, is a board certified in both surgery and vascular surgery. He has been in practice for 14 years in the St. Louis area.