Introduction.
This paper will analyze the leg amputation surgery of Patient X. A general discussion of the nature, indications, and risk factors of amputation will be followed by a look at the patient’s primary health and social care needs, including the biological, psychological, social and environmental factors, in regards to the amputation. The available health and social care services will then be discussed.

Relevant details concerning amputation.
Generally, amputation is used as a treatment of last resort. The most common rationale for this surgery, at least in developed countries, is peripheral vascular disease, which is most often associated with diabetes and atherosclerosis. Once the amputation has taken place, however, technology and surgical techniques are in place to permit the use of prosthetic devices that can have highly realistic use for the patient. The quality of life for amputation patients has increased dramatically over the past few decades, as the usefulness of prosthetic limbs, and education in optimal surgical methodology have both increased substantially (“Amputation”).

In any operation, it is important to consider all of the anatomical systems involved in the procedure. This is particularly so with regard to amputation. This surgery does not just involve bones, but also tissues, and the related blood vessels that ferry oxygen and nutrients in, while carrying out the waste products, such as carbon dioxide. Even though the circulatory system is so pervasive that, in general, no cell in the body is over a handful of microns from a blood vessel, at times this system can still undergo serious blockages. The aforementioned conditions of diabetes and atherosclerosis can cause circulation to be poor; additionally, serious injuries can create a situation where amputation of a leg is necessary (“Amputation”).

At present, there are three primary indicators for amputation: traumatic injury, peripheral vascular disease, or malignant tumors. There are quite a few risk factors to check for before proceeding with the operation, including checking for infections, irregular levels of blood sugar, the prior use of medications to thin the blood, and any allergies to anesthetics or antibiotics.

When checking for these risk factors, there are several guidelines for medical professionals to follow. Clinical testing should check for an odor, or skin that is unnaturally cool, around any pre-existing wound; fever; other wounds or skin ulcers that are visibly infected; patient pain while not moving. Imaging tests should include ultrasound and/or angiography, which will permit the medical professional to determine whether or not blood is currently reaching certain areas of the body. These tests can be augmented by blood pressure tests and/or treadmill tests.

After all of this testing, if it is determined that the patient needs amputation, the next step is to determine the required level of amputation, or how much of the limb actually needs to be amputated. Several factors are taken into account for this decision, including bleeding at an incision point; loss of sensory perception in the limb; redness; skin temperature; and palpable pulse. At this point, patients will also be fitted for a prosthesis, if applicable, so that the device will be ready as soon as possible after the surgery is over (“Amputation”).

During the operation itself, the patient should have several expectations. First, the goal of the surgeon is to preserve as much healthy tissue, skin, and circulatory matter as possible, while removing the diseased portions of the limb. Second, amputation involves general or spinal anesthesia. While the patient is under this medication, there will be systems in place to monitor blood pressure, temperature, brain function, and heart rate. Third, during the incision, the surgeon will leave sufficient amounts of healthy skin to cover the stump for easier healing, and to make sure that rough scar tissue is far enough away from the places where the prosthetic limb will apply pressure. The incisions should be done so that the cut nerve endings will retract below the end of the remaining bone. Afterward, a tourniquet or similar device is put on the limb to cut down on bleeding, so that the surgeon can pinpoint and separate the major blood vessels that remain healthy. Places where bone is uneven are smoothed, to facilitate an ideal fit with the prosthesis. Eventually, the surgeon will loosen the tourniquet and ensure that all points of bleeding are closed off. Temporary drains may be installed for suction and drainage of bodily fluids. Afterward, the surgeon may close the flaps of healthy tissue (closed amputation) or leave the site open for up to 14 days (open flap amputation). A stocking may go over the stump for drainage tubes and/or dressings, and the limb may also go into traction (“Amputation”).

After treatment, there are also some common procedures that patients can expect. Patients generally remain in the hospital for 5 to 14 days after the operation, on a regimen of pain medication and/or antibiotics. In cases of extreme phantom limb pains or emotional issues, psychological counseling and/or drug therapy may be ordered. Physical therapy begins almost instantaneously, and practice with the prosthetic device generally begins within 10 days. The medical care team will need to check for a number of possible problems with the healing process. Examples would include atherosclerosis, malnutrition, infection, diabetes mellitus, or other toxic states (“Amputation”).

Because amputation is generally a procedure of last resort, complications for the patient’s health are generally associated with the prior condition, such as the traumatic injury or the circulatory disease. However, there are some complications that relate to the amputation process itself. These include contractures, or fixed deformities at the joint; necrosis, or death of the skin flaps; opening of the wound; hematoma, or bleeding blood vessels; gangrene, or death of tissue; and mortality, which affects 5-15% of amputation patients (“Amputation”).

The Case of Patient X.
Patient X is a 46-year-old patient who purchased a motorcycle about a year ago. He is slightly overweight, but not anywhere near the point where it has become a risk of diabetes. When he had a physical eighteen months ago, he got a clean bill of health as far as circulation went, with cholesterol counts below 200 and blood pressure in the lower end of the normal range.

However, Patient X’s good health results do not protect him while on the open road. Riding his motorcycle in traffic, he is in a serious accident with a lorry whose brakes had gone out. Of particular concern is his right leg, which was pinned under his bike as he tried to turn and slide under the truck. The medial malleolus and the lateral malleolus have been crushed beyond the possibility of surgical repair, leading surgeons to consider amputation. More….