Complications - Right transfemoral amputation in Fontaine stage IV peripheral arterial disease – Vascular Surgery

Problems with soft tissue coverage

• Too short soft tissue flaps may constrict sutures and result in necrosis and a stump unable to bear weight –> shorten the femur
• Soft tissue flaps with too much volume result in an unstable stump ("floating stump") –> Shorten the soft tissue flaps

Secondary bleeding /hematoma: Breeding ground for infection, dehiscence of myoplastic coverage –> prompt surgical revision

Skin necrosis: Sutures under tension, too narrow skin bridge –> close monitoring of wound and possibly removal of skin sutures/staples while skin is still vital

Muscle necrosis: Inadequate myoplasty/constricting sutures, impaired perfusion in PAD –> surgical revision / debridement, possibly repeat resection

Infection: Surgical revision / debridement, possibly repeat resection, VAC therapy, AST-based antibiotics

Phantom / stump and neuropathic pain: High-dose analgesics / interdisciplinary pain management; instigate effective pain management already before surgery, epidural catheter

Neuroma formation: Sciatic nerve may have been left too long, causing mechanical stress on the nerve (see surgical step 5, nerve transection at least 5 cm proximal to the amputation level) –> high-dose analgesics / interdisciplinary pain management, possibly repeat resection

 Exostoses on the end of the stump: Calcified hematoma, unnecessary periosteum elevation, if painful and not ready for weight bearing –> stump revision

General complications: Cardiac, pulmonary, renal failure requiring dialysis –> multispecialty management