Below Knee Amputation

With ERTL Limb Reconstruction

Although some view choosing below the knee amputation as a failure, most patients are relieved and find that life after amputation has significantly improved. The painful and dysfunctional leg is replaced with an advanced prosthesis that permits return to almost all sports and activities.

Pre-Operative Care

The surgery center will inform you when to arrive and how to prepare for surgery. The day of surgery, the anesthesiologist will administer regional anesthesia known as a popliteal nerve block. You will be placed on your stomach and injected with Novacaine-like medication around the nerve in your leg. This gives complete pain relief that lasts for 12 to 36. Patients report extraordinary satisfaction with this type of anesthesia. Some patients chose an epidural block which numbs both of their legs below the waist. You can discuss this with your anesthesiologist prior to surgery. You will be given antibiotics just before surgery to help prevent infection.

Operative Care

During the surgery you will be undergo general anesthesia. A tourniquet will be placed around your thigh. Incisions will be made around the leg in order to fashion appropriately sized skin flaps. Then the leg will be removed. The Ertl procedure includes creating a cap to the end of the amputated bone.

Immediate Post-Operative Care

Once your anesthesiologist is satisfied that you have recovered you will be permitted to leave the recovery room. You will be admitted to the hospital. Inpatient stays usually vary from 1-3 days. You will be given crutches or a walker and will start physical therapy the day after surgery. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember post operative pain is much easier to control with prevention.

When you plan to schedule surgery, please call one of our staff, at 952-224-8500 or email info@anklefootmd.com. Accommodations will be made to ensure a timely surgery. If you have questions during the post-operative period, please call or email our staff and ask for my medical assistant.

Post-Operative Course – Below Knee Amputation

This timeline is a general guideline. Your post-operative course may vary.

DressingChange dressing 2-3 times per day until the incision is dry.

Elevation 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months.
Motion Bend and fully straighten your knee and hip several times per day. Keep Flow-Tec in place during the night and while walking. Knee contractures occur if the leg is left bent during the recovery period.
Walking You may begin using a prosthesis when the swelling resolves adequately between 4-6 weeks following surgery.
Bathing You may shower 3 days after surgery. Do not bathe until the staples have been removed.
Pain Control Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only). NSAIDS such as Motrin and Naprosyn are good pain relievers as well. Medications like Neurontin, Lyrica, and Elavil are used to relieve symptoms of nerve or phantom pains.
Work Return depends on specific demands. It is safe to return to sedentary work at 14 days post-op. Return to heavy labor will take at least 4 months.
Driving Patients with left leg surgery may drive an automatic transmission. Patients with right leg surgery have special considerations for driving.

Routine Clinic Visits

2 weeks Staple removal and begin working with Prosthetist.
6 weeks Fitting with a temporary prosthesis.
3+ and 6 months Please see me as needed. Call or email my office to inform us of your progress.

Patients who have selected this procedure are generally very satisfied with the results. The decision to undergo an amputation should never be taken lightly; however, most patients who have chosen this course are relieved of both physical pain and emotional stress.

Visit our video center to watch rehab exercise videos that will help you recover after your below the knee amputation surgery.