Amputations

Amputations can be the result of sepsis or be a cause of sepsis.

Your blood plays many roles, one of which is to carry 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 moves 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.

Surgery

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 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 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.

Suggested Citation: Sepsis Alliance. Sepsis and Amputations. 2022. https://www.sepsis.org/sepsisand/amputations/

Updated March 8, 2022.

Read Personal Stories of Sepsis and Amputations

Dawn McPherson

Survivor

I went septic from walking pneumonia on Dec 18, 2004. (Sepsis and Pneumonia) I had all my toes amputated after they turned black on Jan 9. 2005. (Sepsis and Amputations) The heel of my right foot also was black and there was a skin graft performed on it with a piece of skin cut from my thigh. My purpose of submitting this is hopes of finding other survivors like me to help me understand how to walk again. I can walk but am in severe pain and have developed large blisters and callous. Over the last 16 years I have ... Read Full Story

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Mario G.

Survivor, Survivor

My husband, Mario, was an avid triathlete and runner, who one day in 2013 sprained his ankle during a morning jog. In the days that followed, his foot did not improve, and eventually, it swelled to the point he could not place any weight in it, and began suffering from a fever and a general feeling of malaise. Despite displaying classic symptoms of having a septic joint, his doctor dismissed his symptoms repeatedly as those of the flu, and said delay (which lasted for days) made it possible for my husband to develop sepsis. By the time we reached the ... Read Full Story

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Brooke Miller

Survivor, Survivor, Survivor

I got sepsis 5 days after I had surgery for breast implants rushed to hospital. (Sepsis and Surgery) Two weeks in medical coma, 4 weeks ICU, 3 weeks in-house rehab. I had 15 amputations I lost 10 toes, 3 fingers and my breasts. (Sepsis and Amputations) I died in my coma they brought me back chronic pain severe PTSD, anxiety, fibromyasia, neuropothy, and damaged organs kidney, dialysis ( while in coma), 2 blood transfusions, no longer organ donor, no giving blood. I’m on 15 medications daily. My life day to day is a struggle, and I have all the physical and ... Read Full Story

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Kim Smith

Survivor, Survivor, Survivor, Survivor

On the 29th November 2018 I went to hospital feeling as though I was going to die, I was put into an induced coma and spent 9 weeks in the coma. Six of those weeks were in Spain. Then I was flown back to the UK to a hospital near where I live, I was woken after 3 weeks so 9 in total. When I was woken and a bit more with it I realised I couldn’t move, my hands and legs had gone black and died. I was told they needed to be amputated. I was moved to another ... Read Full Story

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David Trinks

Survivor, Survivor, Survivor, Survivor, Survivor

On 10/3/2020 I went to bed at midnight. I woke up at 3am to go to the bathroom, I noticed there was blood coming out from between the toes of my right foot. I went to touch it to investigate, and all the skin sloughed off, I immediately drove to the nearest Emergency Room, I did not have any pain, redness, swelling, nor was it warm to the touch but being a diabetic it was of extreme concern. (Sepsis and Diabetes) While sitting waiting for 2 hours to be seen, my right great toe began to turn blackish. After the ... Read Full Story

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Amputations

Amputations can be the result of sepsis or be a cause of 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.