Limb Amputation

Overview:

The most common location for removing a damaged or diseased limb in dogs and cats is up high where the limb meets the body. This is so that any remaining portion of the leg does not become a problem for the pet. Any portion of a limb that remains may become traumatized during daily activities or interfere with movement.

Partial limb amputations and prosthetic (artificial limb) use in pets is a new treatment option for some patients. As with other procedures, this is not a good option for all pets and all owners. Stump management and prosthetic use require diligent daily care and attention. Some dogs may need several prosthetics over their lifetime.

Signs and Symptoms:

Amputation may be recommended because of cancer, severe trauma, or a birth defect which has resulted in a useless leg. A painful leg, one that is not being used, a limb with a wound or fracture that cannot be fixed due to any of innumerable reasons, may need an amputation.

Diagnostics:

Additional diagnostics will depend on the reason for the amputation and the age and overall health condition of your pet.

Blood work—complete blood count, chemistry, and urinalysis. Used to evaluate the overall health of your pet.
X-rays—of the limb to be removed, the one on the other side to make sure it can support the extra weight, chest or abdominal films to make sure there are no signs of cancer.

Treatment:

For the front leg, the most successful and cosmetic amputation is by “scapulothoracic disarticulation”—the entire limb is removed from the toes to the scapula (shoulder blade). Since the normal anatomy of the front leg only has muscles that attach the front leg to the chest wall, it is straightforward to remove the limb by cutting these muscles and sewing the area closed. This complete removal creates a smooth, well-padded amputation site on the side of the chest that will not get pressure sores or interfere with movement in any way.

For the rear leg, there are two main techniques that are commonly used. The first is a “high femur” amputation that results in a short, well-padded stump at the level of the rump/thigh. The muscles of the mid-thigh are cut and the femur (thighbone) is cut close to the hip. When the tissues are sewn together, this provides good padding for the pelvis when the pet is lying down and offers a cosmetic appearance by maintaining the symmetry of the rump area. The second technique is often used when the disease of the rear leg is in the thigh area; the leg is removed at the hip joint, only the pelvis and the surrounding muscles remain. This amputation technique is very successful as well, with slightly less padding over the amputation site and a less symmetrical appearance.

A third, less commonly, used procedure for hindlimb amputation (typically used for tumors in the upper part of the thigh, hip or pelvis) is a limb amputation with hemipelvectomy, in which part of the pelvis is removed as well. This procedure does change the symmetry of the rump more than other procedures but is well-tolerated.

Aftercare and Outcome:

Most pets are discharged within a week after amputation, depending on their comfort and ability to walk after surgery.

Your pet will come home with oral pain relievers. Adhesive fentanyl patches are used for some patients as well. Some patients may also receive antibiotics after surgery at home. Your pet may come home with a bandage at the discretion of your surgeon. An E-Collar is used in the first 10–14 days to prevent licking or chewing of the incision.

Exercise restrictions following surgery are recommended to protect pets from injury while they gain strength and coordination after amputation:

Your pet should be kept in a comfortable, safe indoor location for 24–48 hours until he/she is very steady on his/her feet. Do not allow free access to stairs or slippery floors.
Sling support can be helpful to assist your pet to rise and balance, especially on slippery or uneven surfaces. For front leg amputees, a sling is placed under the chest. For back leg amputees, a sling is placed under the belly
Avoid any rigorous activity for four weeks. Short, leashed walks are fine.

Complications:

Incisional bruising is common but should improve after several days:

  • Seroma, or fluid under the skin, may develop near the bottom of the incision for a front leg amputation in the first two weeks

  • Infection

  • Neuroma formation: Very rarely, nerves that have been cut for amputation will form little masses of nerve tissue that can be painful. This may require additional surgery or pain medication

  • Hernia formation (occasionally with hemipelvectomy)

  • Hemorrhage (occasionally with hemipelvectomy)


Clients often worry about phantom pain. Pain at an amputation site is not common.

The functional prognosis for dogs treated surgically with amputation is considered very good. The majority of dogs return to a high level of activity and endurance for their age. Following the four-week recovery period, there are no recommended limitations to their lifestyle.

Rear limb amputees tend to return to near normal mobility; forelimb amputees need to adjust their gait more significantly. For the older pet, learning to move after an amputation may take more time.

Ideally, keep your pet on the thin side of normal his/her whole life. Any minor orthopedic condition can progress with arthritis over time with excessive, wear & tear; carrying less body weight will reduce the energy they must use and will relieve some of this stress on the joints of the remaining three limbs.