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Amputation - Toe

 

What is it?

There is not enough blood getting into your toe to keep it alive. The lack of blood causes severe pain and allows serious infection to take hold. The only choice is to take off the toe. Sometimes the toe has shrivelled up and is a nuisance. Sometimes more than one toe needs to come off. Sometimes the operation is done at the same time as an operation on the blood vessels.

The Operation

You will probably have a general anaesthetic, and will be asleep for the whole operation. Sometimes patients are nymbed from the waist down with an injection in the back. Your toe is taken off. The surgeon may need to take off some of the skin from the foot near the toe to get the best healing. Usually the skin can be stitched up over the wound after removing the toe. Sometimes it is better to let the wound heal up by itself without any stitches. This takes 3 or 4 weeks or more. How long you will be in hospital depends very much on your general condition. Ideally you can go home after a day or so. Often patients find it more convenient to stay for a week or longer.

Any Alternatives

If you leave things as they are, your toe will certainly get worse. Infection may spread to your other toes and foot. An operation to bypass or core out your leg arteries will not work in your case. Laser treatment and x-ray guided stretching of the arteries will not work for you. Injecting the nerve to your blood vessels will not work. Antibiotics are not enough by themselves. An alternative to a toe amputation is an amputation higher up. This may heal up better at the cost of loss of part of your limb. Amputations through the foot do not heal very much better than toe amputations, but an amputation just below your knee would heal very well. Overall, your best plan is a toe amputation at the present moment.

Before the operation

Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Please tell the nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually pain-free. It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you cannot pass urine let the nurses know and steps will be taken to correct the problem. The wound has a dressing which may show some staining with old blood in the first 24 hours. The doctors will look at the wound after a week or so. There may be stitches in the wound which will be removed after 10 days or so. If the wound has not been stitched it will be redressed from time to time. You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you want. You will be given an appointment to visit the Surgical Out Patient Department for a check up about one month after you leave hospital. The nurses will advise about sick notes, certificates etc.

After - At Home

You should feel well within a week of the operation. You can lift anything you want once the wound is comfortable. You can drive as soon as you can make an emergency stop without discomfort in the wound and the wound is healed. i.e. after about 4 weeks. You can restart sexual relations within a week or two, when the wound is comfortable. You should be able to return to a your job when the wound is healed.

Possible Complications

Delayed healing sometimes happens. The doctors will talk to you about this. If you think that all is not well, please ask the nurses or doctors. Infection is sometimes seen. You will be given antibiotics to prevent this. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months. 

General Advice

The operation is a small one and usually causes no problems. However trouble with your circulation or diabetes causing the toe to be diseased needs very careful watching. These notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

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