Skip to main navigation Skip to main content Skip to footer For Medicare For Providers For Brokers For Employers Español For Individuals & Families: For Individuals & Families Medical Dental Other Supplemental Explore coverage through work How to Buy Health Insurance Types of Dental Insurance Open Enrollment vs. Special Enrollment See all topics Shop for Medicare plans Member Guide Find a Doctor Log in to myCigna
Home Knowledge Center Wellness Library Leg Amputation

Leg Amputation

Surgery Overview

The decision to have a limb amputated is difficult for the person and his or her doctor. Many times, extensive measures have been tried to save the limb. The major causes of amputation are diabetes and/or peripheral arterial disease that results in either painful, poor limb function or gangrene.

In general, amputation is recommended for:

  • Gangrene with or without infection.
  • Unbearable pain when at rest.
  • Nonhealing, untreatable ulcers.

Tobacco use may be the most important factor in progressing to amputation.

In doing the amputation, the surgeon seeks to remove all dead or dying tissue. Goals of amputation are to relieve pain, encourage wound healing, and increase a person's ability to carry out his or her daily activities.

Amputations and bypass grafting surgery may be planned at the same time to achieve the best results. For example, a person who has gangrene may have an amputation of part of the foot or leg while also having bypass grafting in an attempt to preserve still-living tissue. In a person who is not a candidate for revascularization or who has not had success with previous bypass grafting attempts, amputation alone may be recommended for severe pain at rest, nonhealing ulcers, and/or gangrene.

Preoperative issues in amputations

Preoperative care before amputation is similar to any major surgery. A complete history and physical exam, routine lab tests, a chest X-ray, and an electrocardiogram (EKG or ECG) may be performed.

People with major medical problems, such as diabetes or heart, lung, or kidney problems must be carefully assessed and their medical care optimized before the operation. The importance of the preoperative evaluation cannot be overemphasized. People who have amputations are often chronically or seriously ill. And their risk of dying around the time of the operation as well as in the following years is higher than for other people of the same age.

Amputation levels

The appropriate amputation level depends on a number of factors, including why the amputation is needed, the general health of the person, the possibility for recovery and rehabilitation (rehab), and the probability of adequate wound healing. The aim of an amputation is to remove all dead and dying tissue while creating the most useful limb for recovery and rehab. It is very important to make sure that an artificial limb, if desired, can be appropriately fitted.

A below-the-knee amputation is usually preferable. It provides better mobility. Even if a person is very unlikely to be able to walk because of their general health or other medical conditions, a below-the-knee amputation provides for easier transfers and movement while in bed. Walking on an above-the-knee prosthesis (artificial limb) requires a lot more energy than walking on a below-the-knee prosthesis, although young, relatively healthy people manage much better than older, more frail people do. But when a below-the-knee amputation cannot be done, an above-the-knee amputation has the advantage of easier healing.

Sometimes a bypass grafting operation may be done to allow a below-knee amputation site to heal adequately. The most important thing in deciding whether a below-knee amputation will heal is the clinical judgment of a knowledgeable surgeon.

Timing of surgery

In general, amputations for sudden ischemia (when a clot develops and completely blocks blood supply to an extremity) are done to control pain soon after the preoperative evaluation is finished, if possible.

Bypass surgery or angioplasty is always done when possible. Amputation is the last option.

Noninfected gangrene of the fingers and toes can be treated by amputation or can be allowed to "autoamputate" (tissue dies and sloughs off on its own) over a period of time, usually months. Gangrene of other extremities requires amputation.

Infected gangrene should be treated with the goal of getting rid of the infection yet preserving as much of the extremity as possible. Dead or dying infected tissue should be removed (debridement) as quickly as possible. Tissue that is infected but may likely heal should be left. And the person should receive intravenous antibiotics.

If a person is not stable or does not respond to antibiotic treatment and debridement, amputation must be done rapidly. A first emergency amputation is often done with the goal of stabilizing the person. And a second elective operation may be done to remove any further dead tissue and to improve the function of the remaining limb.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

© 1995-2022 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Related Links

Peripheral Arterial Disease of the Legs

<cipublic-spinner variant="large"><span>Loading…</span></cipublic-spinner>

Page Footer

I want to...

Get an ID card File a claim View my claims and EOBs Check coverage under my plan See prescription drug list Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna

Audiences

Individuals and Families Medicare Employers Brokers Providers

Secure Member Sites

myCigna member portal Health Care Provider portal Cigna for Employers Client Resource Portal Cigna for Brokers

Cigna Company Information

About Cigna Company Profile Careers Newsroom Investors Suppliers Third Party Administrators International Evernorth

 Cigna. All rights reserved.

Privacy Legal Product Disclosures Cigna Company Names Customer Rights Accessibility Non-Discrimination Notice [PDF] Language Assistance [PDF] Report Fraud Sitemap

Disclaimer

Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities  that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details