Amputations can be the result of sepsis or be a trigger for sepsis.
Your blood plays many roles. Its most important is that it carries oxygen and nutrients to the organs and tissues throughout your body, from your brain to your smallest toe. After it provides the nutrients, the blood then collects the waste products and flows back to the heart and lungs for refreshing.
Usually, blood flows through your blood vessels (arteries, veins, capillaries) in a very fluid form, driven by your pumping heart, only clotting when the body senses it is necessary. Once in a while, the system does cause problems, and clots may develop somewhere in the body where there shouldn’t be one. When a clot forms in a blood vessel, blood can back up behind if there is a complete blockage, or can be slowed down significantly if there is still room for some blood to pass. Some common examples of health problems caused by blood clots are deep vein thrombosis (DVT) and some types of strokes.
As of 2020, physicians are finding that many people who contract the novel coronavirus that causes COVID-19, develop blood clots. Some of these clots are causing strokes or heart attacks, but others are causing blockages that cause enough damage to require amputations.
Sepsis and blood clots
When someone has sepsis, the clotting mechanism works overtime. As nutrients cannot get to the tissues in the fingers, hands, arms, toes, feet, and legs, the body’s tissues begin to die and can cause gangrene. At first, the skin may look mottled, bluish purple, and then black. This dead tissue must be removed because it can cause infection to spread. If the gangrenous area is small enough, the surgeon may be able to remove just enough to stop the spread. However, if the damage is extensive, an amputation may be needed.
There are many causes for amputations, from traumatic injury and illnesses, such as sepsis. According to the Amputee Coalition, there are approximately 2 million people in the country who have some sort of amputation and there are about 185,000 amputations each year. There are, on average, about 38 amputations a day due to sepsis and about 1% of sepsis survivors undergo one or more surgical amputations of a limb or digit as a result of sepsis. This could be one limb on a patient or multiple fingers/toes and limbs.
The decision to amputate is based on making sure enough tissue is removed to ensure that all the damaged tissue is gone, but also trying to preserve the patient’s independence and mobility as much as possible. It is important to understand that sometimes after the surgery has begun, the surgeon may have to do a larger amputation than originally planned. Much of the procedure depends on the condition of the muscles and the skin.
Once the amputation is complete, the surgeon has two options: leave the site open or close it up right away. An open site, where the incision is not sewn or stapled closed, allows the doctors and nurses to monitor for and remove any infected tissue that might have been left behind. If this procedure is chosen, the surgeon will close up the flap once he or she is sure that the site is completely clean and infection-free.
After the surgery
The length of time to recover from an amputation depends on many things:
- The location
- The number of limbs amputated
- The reason for the amputation
- The medical condition of the patient following the surgery
Ideally, patients who have had an amputation will begin physiotherapy as soon as possible. Physiotherapy may include stretching and increasing muscle strength or learning how to transfer from a bed to a chair if a leg or legs were amputated. Occupational therapists also play an important role in helping amputees learn how to use special tools or adapt their living environment as needed.
How long it takes for the limb to heal depends on many things, but the ideal healing time for the incisions is about four to eight weeks.
Pain can be a big issue for amputees. They have the pain from the amputation, but they may also experience phantom limb pain – pain coming from the limb that is no longer there. It is estimated that as many as 80 percent of amputees feel some level of phantom pain. This type of pain can be hard to manage because it is not understood. It’s not like a cut or a swelling, for example. However, that doesn’t mean you have to suffer needlessly. There are treatments that have been successful for some people, but you may have to try different approaches before you find one that works for you.
The NLLC has a good pain information fact sheet to help you learn about the types of pain, how to describe it, and how best to talk to your healthcare providers.
Adapting to prosthetics after amputations
The move from amputation to prosthetics can be a fast one. If the patient is strong enough and is healing well, a temporary leg prosthetic could be tried within a week or two of the amputation. It is important to get up and moving about as quickly as possible to prevent physical complications and also for mental and emotional well-being.
As with just about everything else in life, there is no one-size-fits all type of prosthetic. What works for one person who may have a similar amputation as you, may not work for you, and the other way around. The people who design the limbs and the physiotherapists use their expertise to try to find the best match for each person. Some prosthetics are purely cosmetic, others are mechanical, and yet other, newer ones, are robotic. There is a tremendous amount of research going on to help improve the lives of amputees who rely on prosthetics. Remember, it may take a good bit of trial and error to get your prosthesis to be as good as it can be for you.
Sores and infections from amputations
When you get a new prosthetic, you must watch for signs of sores developing on your skin from pressure or rubbing against the device. Any wound is vulnerable to infection, so if you notice a sore forming, inform your healthcare team as quickly as possible. Your device may need alterations. Watch for signs of infection: increasing redness around the sore, pus or discharge, increased pain, foul odor. If you notice any signs, seek medical help immediately. The quicker an infection is spotted and treated, the lesser the risk of developing sepsis.
Information regarding sepsis and amputations is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Updated August 9, 2020.