Amputations are required for a whole host of reasons, some are due to a negligent act but some are not.
The most common reason for an amputation is poor circulation. Poor circulation occurs because of damage to, or narrowing of arteries. This is also called Peripheral Arterial Disease (PAD). When blood flow is restricted, cells are starved of oxygen and the tissue starts to die off causing an infection.
If you have an infection and it does not respond to antibiotics, amputation may be the only solution left to medical experts.
You may also need an amputation because of a significant injury sustained in an accident or because of cancer in the bones or muscles. You may have thickening of nerve tissue (neuroma), this is also a reason that you may require an amputation.
Common conditions which can cause the need for amputation
Commonly occurs in arms and legs when the pressure in muscles builds. The pressure can build to such an extent that it presses against arteries and reduced blood flow. There are two classifications for Compartment Syndrome, Acute and Chronic. Compartment syndrome is classed as a medical emergency if it reached the level of acute whereas chronic is not an emergency because it is usually caused by exercise.
Conditions that can bring on acute compartment syndrome include fractures, a badly bruised muscle, blocked circulation becoming unblocked suddenly, injuries sustained in a crush, steroid use or even bandages and casts being too tight.
Is an infection in a bone, typically in legs or arms and is bacterial in nature. It has two classifications, Acute and Chronic. Acute osteomyelitis occurs when an infection starts after an injury or infection whereas chronic osteomyelitis is when the condition keeps coming back.
NHS Choices say that 30 to 40% of diabetic sufferers who have a puncture injury to their foot will develop this condition.
Peripheral Vascular Disease (PVD)
A condition related to blood circulation which causes blood vessels to narrow or block. The causes of PVD include hardening of the arteries (arteriosclerosis) and blood vessel spasms.
Arteriosclerosis is where cholesterol builds up in arteries causing narrowing and hardening. As well as PVD, Cholesterol plaques are commonly the causes of heart attacks and strokes because the plaque can rupture suddenly. The blood clot that forms where the rupture occurred can break off and cause a blockage, this is in the same way that a scab forms when we cut or graze ourselves.
Arterial meaning “of the artery” and Embolism meaning “clot” is where blood flow to a body part or organ is suddenly stopped. The clot has formed in a different part of the body and has travelled to the new location via the arteries. Arterial embolisms are usually found in legs but can be found in other areas such as in the brain (stroke) or heart (heart attack).
Foot Ulcers / Infections
Are commonly caused by peripheral neuropathy (nerve damage), circulatory problems or abnormalities in bones or muscles.
Nerve damage is most commonly caused by diabetes. Nerve damage means that the sufferer may not feel pain in the feet. When damage to the skin on feet happens and the diabetic does not feel pain, ulcers form.
Poor circulation in legs is called peripheral artery disease (PAD) and is linked with atherosclerosis. Because of reduced blood flow, cells receive less oxygen making skin more susceptible to injury.
It is thought that 80% of the 135 leg, foot or toe amputations that happen every week could be avoided if the appropriate checks and care was provided but around 20% of diabetics do not get annual foot checks.
In diabetes patients, nerve damage, poor circulation and numbness in legs and feet are often a precursor for more serious problems and could indicate that the patient is poorly managed.
The next step is when ulcers start to form. When nerves become damaged, numbness is often experienced. When a diabetic cannot feel pain because of nerve damage, they are more susceptible to injury. For example, if a diabetic were to get a small stone in their shoe, that stone can rub and cause foot ulcers. Because of numbness, that person wouldn’t know they had an injury unless they carried out foot checks regularly.
It is when foot and leg checks are not carried out that amputations are necessary. The ulcers could have caused gangrene making amputation the only course of action available.
See our article on diabetic care plans here
An audit in 2015 showed 29% of diabetic inpatients had foot checks within 24 hours of admission to hospital. Any diabetic patient with a foot infection or ulcer should be urgently seen by a member of the diabetic multi-disciplinary team (MDT).
The MDT should include physicians, nurses, podiatrists, dieticians and clinical psychologists however 31% of hospitals do not have a diabetic MDT.
In 2014, a report found the following experts were used in MDTs
|Medical Speciality||Patients with Diabetes||Patients without diabetes|
|Diabetes nurse specialist||5||24|
|Vascular ward nurse||36||34|
|Representative for immediate care||3||3|
Amputation negligence claims are not always as a result of any medical condition, there are instances classed as “never events” where the wrong body part was amputated in error. A person could have been seriously injured in an accident or fire and the treatment given was substandard resulting in amputation being unavoidable.