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General Principles of Revision Surgery

Posted by Bryan Potok, CPO on

Revision surgery isn’t something to be taken lightly; it’s more complicated than your initial amputation surgery, and it entails many of the same risks. Nevertheless, many amputees undergo revision surgery to eliminate problems such as pain and infection, among others. 

An above-the-knee amputee consulting with his physician for revision surgery

Revision surgery is an event that brings a lot of tough questions and decisions. When your physician begins mentioning surgery, you will understandably feel overwhelmed at the thought of yet another amputation surgery. So it's important to listen and ask questions to help you make an informed decision and ease any related anxiety. The outcome can drastically improve the quality of your life.

Potential Success

One of the most common questions that surround revision surgery is its potential for success. In this case, "success" is defined as the relief of the initial problem, and "failure" is defined as persistence of the initial problem, which often requires one or more additional surgical procedures.

One study, which discusses the value of revision surgery when performed six weeks after the initial amputation surgery, can help shed some light. According to the study, when the surgery was performed to eliminate pain in the residual limb and/or phantom limb pain, only 35% of amputees reported satisfactory results after one revision. Meanwhile, 26% of amputees required four or more surgical revisions without relief from pain.

However, the study found that when the surgery was carried out to address disease, a 100% success rate was reported. Revision surgery for treatment of chronic infection, removal of bone spurs, revision of skin grafts, and improvement of the residual limb for prosthetic fitting was a success for 85% of patients after the first revision. After a second procedure, the success rate went up to 100%.

What is Revision Surgery?

As the name suggests, revision surgery refers to the revision of a residual limb months or years after skin closure. This is commonly suggested by your physician to facilitate a better fitting prosthesis or improve weight bearing on a prosthesis. Revision surgery is often recommended for those who encounter limb problems which are common complications experienced by those who have suffered from a traumatic amputation. These problems include adhered skin, scars, ulcers that refuse to close, excess soft tissues, a prominent bone under the skin, and residual limb pain caused by spurs or neuromas

Some of the reasons for considering revision surgery include:

  • General pain and/or phantom limb pain.

  • Late infection within the residual limb.

  • Symptomatic bone spurs.

  • Neuroma that creates localized "hot spots."

  • Painful scars tethered to a bone.

  • An absorbable suture that hasn't been absorbed.

  • Beveling a bone to make weight-bearing less painful.

  • Revision of skin graft to conserve limb length.

  • Changing or improving the shape of the residual limb with the intent of improving the prosthetic socket fit.

Surgery Goals

Revision surgery aims to remove the cause of the problem and to keep the length of a residual limb as long as possible. When dealing with amputation due to disease, the surgeon's first and foremost goal is to remove enough of the limb to ensure the elimination of the disease. For example, when amputating to stop the spread of a malignant tumor, the surgeon's objective is to remove any portion of the limb or tissue that may be infected by the malignancy.

Further goals of amputation surgery include leaving a scar that will heal well and is painless, retaining as much functioning muscle as possible, successfully managing nerve ends, and proper management of remaining bone.

Your Revision Goals

Part of your preparation for revision surgery includes defining a clear path ahead with the intent to return to your new, equally fulfilling normal. Create a broad overall goal comprised of smaller achievable goals. When setting goals for yourself, it's best to discuss with your physician and prosthetist so they can guide you towards attainable goals.

It's also essential to build a support team to help keep you motivated. Consider taking advantage of the Amputee Coalition's Peer Visitor program or joining a support group.  During this time, it's crucial that you maintain healthy and positive thoughts as well as emotions throughout the process.

If you have questions, please send us an email or add a comment below. 
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