Patient Information – Consent for Toe Amputation
The intended benefits: as a last resort to remove the underlying foot problem reducing your quality of life and to prevent spreading infection or gangrene; only when all other options to save the toe(s) have been considered or tried. Any number of toes may be taken.
Alternative treatments: some patients may live on with supporting treatment for some time, especially if the foot has been a chronic, not acute problem. However, pain, infection, blood poisoning and serious illness continue to be real and significant risks.
Serious or frequently occurring risks: around one in five patients experience a problem with wound healing which may require further surgery (debridement) or a revision to a higher level. This poor healing is more common the further down a leg or foot the amputation. It is often associated with infection and needs antibiotics, dressings, and pain relief. You may trip or fall over and so may injure yourself or your amputation wound. Much bleeding from the wound is rare because we take great care to avoid it and wrap up the wound well but it may occasionally require a return to the operating theatre. Up to one in ten patients may develop a blood clot in their leg veins (DVT). This can occur in either leg and is treated by injections (enoxaparin or Clexane) and then tablets (Warfarin) to reduce the tendency of blood to clot (often termed “thinning the blood”); DVT usually resolves but occasionally may leave a chronically swollen leg or clot may pass to the lungs (pulmonary embolism or PE) which can be dangerous (1 in 10 DVTs). The infection in your foot puts strain on essential organs, especially the kidneys so, because patients are often unwell when amputation is needed, there are more general risks due to the extra stress of surgery and anaesthetic. These include heart attack or failure, chest infection, pulmonary embolism, stroke and kidney failure. Overall, death occurs in below 5% of patients when the operation is planned ahead as a “routine case” but in urgent or emergency situations rises to 10-20% despite all the supportive care that we can give. Unwell patients spending long periods in bed are also prone to developing be sores, especially on the heels and bottom. These still occur despite good nursing care and special beds and mattresses.
Modern anaesthetics are generally very safe and you will have the opportunity discuss this in detail with your Anaesthetist. In most patients, a local anaesthetic injection or sedatives plus injections in your back to numb the lower half of your body (epidural or spinal anaesthetic) are preferable as these avoid any complications from general anaesthesia.
Commoner side effects of an epidural or spinal anaesthesia include:
- Inability to pass urine: bladder function will return to normal after the epidural wears off
- Low blood pressure
- Itching, feeling sick and vomiting or headache
- Backache is common after surgery and not always related to the epidural
- Inadequate pain relief- other methods of pain relief will be used if the epidural fails.
Uncommon complications include slow breathing and epidural catheter infection. Rare or very rare complications include fits, permanent disabling nerve damage, epidural infection, epidural blood clot and cardiac arrest.
Whilst general anaesthetic is not often used for toe amputations, commoner side effects(1 in 10-100) include: nausea or vomiting, sore throat, dizziness, blurred vision, headache, itching, bruising and soreness, pain during drug injection, confusion or memory loss, aches, pains, slow breathing, damage to teeth, lips or tongue or worsening of an existing medical condition. Rare complications (1 in 10,000-100,000) include damage to the eyes, serious allergy to drugs, nerve damage, awareness during surgery, equipment failure and death.
Any extra procedures which may become necessary during the operation:
- Blood transfusion is rarely needed unless you are already anaemic but transfusions can result in severe allergic reactions or infections despite careful screening of the blood for you
- Photographs and images X-rays are a usual part of this operation but if we want images for teaching or research purposes, we would always ask your special permission
- Other procedures, except for those listed above, are not often required during this operation unless planned in advance, the problems listed above can lead to additional procedures as described.