veterinary limb amputation on cats and dogs
What is a veterinary Limb Amputation on a dog or cat?
Amputation involves the surgical removal of a body part that is diseased or damaged beyond salvage. In dogs, the parts more commonly amputated are a limb, toe(s), or the tail. It should be remembered the docking the tail of newborn pups is an act of amputation. The aim of amputation is as a salvage procedure to prevent pain or suffering by removing a damaged body part or to prevent the spread of certain aggressive forms of cancer. This is a surgical procedure commonly undertaken in first opinion practice. Whilst amputation may seem a radical option to us, dogs do not seem to experience the same mental sense of loss as humans, and the vast majority adapt extremely well to the loss of a limb. Indeed there is a saying in veterinary circles that dogs have “Three legs and a spare.”
Limb amputation can be performed on dogs or cats when necessary to remove a damaged or diseased leg that can not be saved by other medical or surgical means. This surgery can be performed on either front or rear limbs and is usually performed high up, close to the body, so the remaining limb does not interfere with movement. Partial limb amputations, allowing the use of prosthetics, are not common in dogs, as dogs have traditionally adjusted well to full limb amputation and availability of prosthetics was limited. However, with new prosthetics and procedures becoming available, prosthetics are becoming more commonly used than in the past.
Limb amputation may be performed by your veterinarian under general anesthesia when a cancerous tumor is present, due to fractures that will not heal, or due to rampant infection that will not resolve and threatens your dog’s overall health. Dogs quickly learn to adapt to only having three legs and do not seem to experience distress from this condition in the long term. If more than one limb requires amputation adjustment may be more difficult.
Limb Amputation Procedure in Dogs
This is a surgical procedure that requires full general anesthesia. First the patient should be thoroughly assessed to check there are no other treatment options and that amputation is the most humane treatment. Prior to amputation your veterinarian will perform tests including blood work to determine overall health and fitness for the procedure, unless amputation is urgent, as may be the case in acute trauma or infection. You will be required to fast your dog from food prior to administration of general anesthetic. Your dog will be sedated, administered an intravenous line through which analgesics, antibiotics and anesthetic will be administered, along with electrolytes and other supportive measures required. Anesthetic will be administered by intubation and maintained by gas for the duration of the procedure. Pain killers will be administered prior to surgery and post surgery. Epidural analgesia may be administered for rear leg amputations to further control pain.
The area to be excised is shaved and cleaned. Sterile surgical drapes are used. An incision will be made in the skin around the site for limb amputation, major arteries and veins will be double litigated as they are encountered. Blood vessels to muscles are maintained as much as possible and hemostasis when muscles are incised with a scalpel is achieved with electrocautery or litigation. Muscle is preserved where possible, however when tumors are being removed healthy tissue margins must be removed along with the lesion. Nerves are pulled back and severed and allowed to retract. Care to avoid crushing nerves is taken. If a previously repaired fracture with metal is present, all surgical metal will be removed. If infection is present a culture will be taken to aid in customization of antibiotic therapy. Prior to cutting of limb bones the periosteum is excised and scraped back from the level amputation is to take place, to avoid leaving tissue at the bone stump, which may cause spur formation.
In the forelimb, the limb may be removed at the level of the humerus or the scapula may be included. For hind limb amputations, the location of the disease or damage may dictate where amputation occurs, although the upper third of the thigh bone is a common site, allowing muscle to be used to cover the limb stump. If a cancerous lesion occurs higher up on the hind limb the amputation may be performed higher up on the hip joint or may include part of the pelvis.
Bone is cut with a saw, wire or bone cutters. Bone ends are smoothed with a file. If a cancerous tumor is present, tissue from the amputated limb may be sent for evaluation by a veterinary pathologist.
Muscles are sutured with absorbable sutures, drains may be placed in gaps to allow drainage of fluids for 48-72 hours post surgery. Skin is sutured so as not to create pressure points, create unwarranted tension or leave loose skin. Your dog will be put in recovery and provided supportive care during recovery from anesthesia. Vital signs will be monitored and pain, hypothermia, or bleeding addressed. Your dog may be assisted with standing and walking so as not to further traumatize the surgical site.
After amputation in the forelimb, bandaging with soft padding is placed over the surgical site to provide protection. Bandaging is less often used in the hind limbs. The procedure takes between one and two hours including anesthesia, addressing blood and nerve supply to the limb, and the amputation procedure.
From start to final suture removal, a typical timeline is 10 – 14 days. In the majority of cases where amputation is necessary, the dog hasn’t been using the limb for some time. This means once the anesthetic and discomfort of surgery has worn off, the majority of dogs adjust remarkably well. Indeed, some are noticeably brighter and more mobile than pre-surgery because they no longer experience pain or discomfort from the diseased limb.
Efficacy of Limb Amputation in Dogs
Dogs adapt well to limb amputation with little distress and are able to run and play with minimal limitations. If disease was present, amputation may provide immediate resolution of pain and the dog may be relieved to be free from discomfort. Older pets may take longer to adjust to life on three limbs. Any portion of a limb remaining is prone to interfere or may be injured from daily activities and usually this is avoided by removing most of the limb. Prosthesis are rarely used unless bilateral amputation is required, although they are becoming more common and effective as knowledge of procedures and improved prosthetics for dogs become available.
Limb Amputation Recovery in Dogs
After surgery your dog will be administered analgesics and antiinflammatories. If pain was present in the limb prior to surgery your dog may experience relief from that pain with limb removal and adjust quickly. Your dog may be hospitalized for one to two days or may be sent home the same day. Medications should be administered as directed. If a drain is present, ensure it does not become dislodged prior to your veterinarian removing it in one to three days. The incision will need to be monitored for signs of wound dehiscence, infection, or bleeding and veterinary care obtained immediately if this occurs. Bruising and swelling will occur. Your dog should be put on restricted activity until wound healing occurs and stitches are removed at one to two weeks. An e-collar may be used to prevent your dog from licking and chewing their surgical wound. You may use a sling around their belly to help them with mobility in the first few days if needed. Exercise should be limited for up to four weeks post surgery and your dog maintained on a leash when outside. Limiting roughhousing with other animals is also advisable during the recovery period.
During recovery, regular activity should be introduced gradually, until your dog learns to adapt to prevent injury. Slippery floor surfaces, stairs, and furniture may present challenges at first, and avoiding these hazards until your dog has time to adjust may be helpful at preventing injury during recovery. It is important to ensure that dogs with limb amputation maintain a healthy weight so as not to put stress on remaining legs.
Dog Limb Amputation Considerations
Complications such as hemorrhaging, fluid build up and infection can occur post surgery. Nerve damage can also result from amputation, causing further discomfort, although this is rare. Arthritis in remaining limbs can occur especially if the dog becomes overweight.
Limb Amputation Prevention in Dogs Although neoplasia can not be avoided, the risk of trauma requiring limb amputation can be minimized. Keeping your dog in an enclosed area or on a leash when outside will reduce the risk of being hit by a car, being involved in other accidents, or fights with other dogs that can result in irreversible limb damage. Treating disorder such as infection immediately, before it becomes established and comprises the limb, will also reduce the likelihood that infection of a limb will result in amputation being necessary.