An amputation is a specialized surgical procedure that involves the removal of a limb or portion of a limb that is damaged, diseased, or non-functional. At our practice, we understand that facing an amputation is a profoundly life-changing event with significant physical and emotional implications. That's why we're committed to providing compassionate, expert care while helping you understand each step of your treatment and rehabilitation journey. This procedure becomes necessary when preserving a limb is no longer possible due to severe trauma, advanced infection, vascular disease, or malignancy, and the goal is to create a functional residual limb that optimizes mobility, minimizes pain, and allows for effective prosthetic use when appropriate.
At Lifetime Surgical, our approach to amputations utilizes advanced surgical techniques tailored to the specific level required:
Above-Knee Amputation (AKA/Transfemoral): Involves removal of the leg above the knee joint, preserving as much of the femur as possible to allow for better prosthetic fitting and control.
Below-Knee Amputation (BKA/Transtibial): Removes the foot and part of the lower leg while preserving the knee joint, offering significant functional advantages including more natural gait, less energy expenditure during walking, and easier prosthetic use.
Transmetatarsal Amputation (TMA): A partial foot amputation that removes the toes and part of the forefoot while preserving the hindfoot and ankle, allowing for walking without necessarily requiring a prosthesis.
Our comprehensive approach includes meticulous surgical technique, expert pain management, emotional support, and coordination with rehabilitation specialists to optimize your recovery and long-term function following amputation.
You may need an amputation if you experience:
Severe trauma with irreparable damage to a limb
Critical limb ischemia with non-salvageable tissue due to peripheral vascular disease
Diabetic foot ulcers that have progressed to gangrene or severe infection
Life-threatening infection (gas gangrene, necrotizing fasciitis) not responsive to antibiotics
Failed revascularization procedures in a severely compromised limb
Malignant tumor (bone or soft tissue) requiring removal
Severe, chronic infection (osteomyelitis) unresponsive to treatment
Congenital limb deformities causing significant functional impairment
Irreversible cold injury (severe frostbite)
Non-healing wounds despite optimal care
Severe, chronic pain in a non-functional limb
Failed previous limb salvage procedures
Massive crush injury with non-viable tissue
Severe, irreparable nerve damage causing a non-functional limb
Life-threatening conditions requiring limb sacrifice to save life (e.g., severe sepsis)
Symptoms indicating a potential need for amputation:
Persistent severe pain not controlled with medication
Complete loss of sensation in the affected limb
Absence of pulse in the affected limb
Cold, pale, or blue skin
Visible gangrene or tissue death
Progressive infection despite antibiotics
Uncontrollable bleeding from damaged blood vessels
Severe deformity preventing functional use
Overwhelming sepsis originating from the affected limb
Our approach to amputation combines precise surgical technique with comprehensive perioperative care. The procedure begins with a thorough evaluation to determine the optimal level of amputation that balances the removal of diseased tissue with preservation of function. What sets us apart is our multidisciplinary approach involving vascular surgeons, orthopedic specialists, rehabilitation experts, prosthetists, and mental health professionals who collaborate to create an individualized treatment plan.
For Above-Knee Amputation (AKA): The procedure involves careful dissection at the determined level of the femur, typically preserving as much healthy femur as possible while ensuring adequate soft tissue coverage. We meticulously identify and individually ligate major blood vessels while carefully managing nerves to minimize postoperative neuroma formation. The femur is transected with precision and contoured to create a smooth, rounded end that will interface comfortably with a prosthesis. Meticulous myodesis or myoplasty techniques are employed to stabilize the residual muscles to the femur, creating a strong, functional residual limb that facilitates prosthetic use.
For Below-Knee Amputation (BKA): This procedure preserves the knee joint, offering significant functional advantages. We carefully fashion posterior muscle flaps that provide excellent soft tissue coverage over the tibia, which is transected with meticulous attention to creating a properly contoured end. The fibula is typically cut slightly shorter than the tibia to prevent painful pressure points. Special attention is paid to nerve handling and myofascial closure techniques that create an ideal weight-bearing surface for prosthetic fitting.
For Transmetatarsal Amputation (TMA): This procedure preserves the hindfoot and ankle function while removing non-viable forefoot structures. We create carefully balanced dorsal and plantar flaps to ensure proper coverage of the metatarsal ends, which are contoured to minimize pressure points. Special attention is paid to biomechanical balance to prevent future deformities that could lead to ulceration or the need for higher-level amputation.
For all amputation levels, our distinctive approach includes:
Comprehensive preoperative vascular assessment to determine optimal amputation level
Advanced pain management protocols, including preemptive analgesia and regional nerve blocks
Meticulous surgical technique focused on creating optimal residual limbs for prosthetic fitting
Early involvement of physical therapy and rehabilitation specialists
Psychological support throughout the perioperative period
Seamless coordination with prosthetists for timely fitting when appropriate
This multidisciplinary approach ensures not only successful surgical outcomes but also supports your entire journey through rehabilitation and adaptation to life after amputation.
Immediate Post-Procedure (1-7 days)
All Amputation Levels:
Expect to remain hospitalized for 3-7 days depending on the level of amputation and overall health
Receive comprehensive pain management, potentially including regional nerve blocks and medication
Experience some pain, swelling, and drainage at the surgical site
Begin early mobilization with physical therapy, often starting the day after surgery
Learn proper positioning of the residual limb to prevent contractures
Understand proper wound care and dressing management
Begin learning transfer techniques (bed to chair)
Experience phantom limb sensations (feeling that the amputated limb is still present)
Receive emotional support and counseling as needed
Begin work with occupational therapy for activities of daily living
Learn proper residual limb positioning to prevent contractures
For Above-Knee Amputation:
Start gentle exercises to prevent hip flexion contractures
Learn proper positioning with no pillows under the residual limb
Begin early mobility with assistive devices (walker or crutches)
Begin gentle strengthening of hip muscles
For Below-Knee Amputation:
Special attention to preventing knee flexion contracture
May be fitted with a rigid post-operative dressing or removable rigid dressing
Begin knee extension exercises
For Transmetatarsal Amputation:
Special attention to preventing equinus deformity (foot pointing downward)
May be fitted with a specialized post-operative shoe
Begin gentle ankle range of motion exercises as directed
Short-Term Recovery (1-6 weeks)
All Amputation Levels:
Attend follow-up appointments for wound checks and suture removal
Continue prescribed pain management regimen
Begin more intensive physical therapy program
Learn residual limb care, including washing, inspecting, and moisturizing
Begin residual limb wrapping or shrinker application to reduce edema and shape the limb
Monitor for signs of infection, delayed healing, or wound complications
Continue psychological support as needed
Progress mobility training with appropriate assistive devices
Begin preparation for prosthetic fitting when appropriate
Establish a regular exercise program to maintain strength and flexibility
For Above-Knee Amputation:
Focus on hip extension, abduction, and adduction exercises
Learn to prevent and manage phantom limb pain
Typically begin prosthetic evaluation at 4-6 weeks if healing well
Practice advanced transfer techniques
For Below-Knee Amputation:
Focus on knee extension and strengthening exercises
May begin early prosthetic fitting with temporary prosthesis (3-8 weeks)
Learn proper residual limb wrapping techniques to prepare for prosthesis
For Transmetatarsal Amputation:
May begin weight-bearing with special shoes within 2-3 weeks if healing properly
Focus on ankle mobility and strength exercises
Learn proper foot care and inspection techniques
May be fitted with custom orthotic devices
Long-Term Recovery (6 weeks - 6 months)
All Amputation Levels:
Continue with rehabilitation program, gradually increasing the intensity
For prosthetic users, begin gait training with the prosthesis
Adjust to volume changes in the residual limb
Learn proper prosthetic care and maintenance
Gradually increase activity levels and endurance
Continue psychological adjustment and support
Begin integration of prosthesis into daily activities
Participate in progressive strengthening exercises
Learn to monitor for skin issues and address them early
May begin driving with adaptations if appropriate
Consider participation in support groups
Follow-up appointments become less frequent if healing well
For Above-Knee Amputation:
Learn advanced prosthetic gait training techniques
Practice walking on varied surfaces and stairs
Higher energy expenditure with walking requires focused endurance training
May require a longer rehabilitation period than more distal amputations
For Below-Knee Amputation:
Progress to definitive prosthesis typically within 3-6 months
Develop a more natural gait pattern with prosthesis
Practice advanced mobility skills including uneven terrain
May return to many pre-amputation activities with appropriate prosthesis
For Transmetatarsal Amputation:
Progress to definitive footwear with custom orthotics
Focus on balance and proprioception training
Learn strategies to prevent skin breakdown
May achieve near-normal gait pattern
Long-Term Expectations
All Amputation Levels:
Continued maturation of the residual limb over 12-18 months
Periodic prosthetic adjustments or replacements as needed
Lifelong attention to skin care and inspection
Regular follow-up with healthcare team, typically annually once stable
Potential for high level of function and independence
Ability to participate in adaptive sports and recreation
Ongoing vigilance regarding the contralateral limb for those with vascular disease
Management of phantom limb sensations, which may persist but typically diminish
Potential need for prosthetic upgrades as technology improves
Progressive return to desired activities and life roles
Adaptation strategies for varying environmental conditions
For Above-Knee Amputation:
Higher energy expenditure for walking (approximately 65% increase)
May achieve community ambulation with appropriate prosthesis and training
May benefit from advanced prosthetic components (microprocessor knees, etc.)
For Below-Knee Amputation:
More efficient gait pattern than AKA (approximately 25% increased energy expenditure)
Excellent functional outcomes with proper prosthetic fitting
Many return to previous occupations and recreational activities
Better balance and stability than higher-level amputations
For Transmetatarsal Amputation:
Most achieve household and community ambulation without a prosthesis
Special footwear typically required long-term
Monitoring for pressure points to prevent skin breakdown
May require minimal adaptations for many activities
Generally good long-term functional outcomes with proper foot care
Common Side Effects
All Amputation Levels:
Pain at the surgical site during healing
Phantom limb sensations (non-painful awareness of the missing limb)
Phantom limb pain (painful sensations in the missing limb)
Temporary swelling of the residual limb
Bruising around the surgical site
Mild drainage during initial healing
Residual limb volume changes over time
Skin sensitivity around the incision
Muscle atrophy in the residual limb
Temporary dependency on assistance for mobility
Emotional adjustment reactions
Mild scarring at the incision site
For Higher-Level Amputations (AKA/BKA):
Greater initial mobility challenges
Longer adjustment period to prosthetic use
Higher energy expenditure during walking
Increased risk of joint contractures without proper positioning
Less Common Complications
All Amputation Levels:
Wound infection (5-15%)
Delayed wound healing
Wound dehiscence (opening of the surgical site)
Hematoma formation requiring drainage
Development of painful neuromas
Joint contractures (preventable with proper therapy)
Bone spur formation
Skin irritation or breakdown at the residual limb
Phantom limb pain that becomes chronic and difficult to manage
Prosthetic fitting challenges
Development of bony prominences causing pain
Psychological adjustment difficulties
Residual limb pain distinct from phantom pain
Heterotopic ossification (abnormal bone formation)
For vascular patients, progression of disease in the remaining limb
More Serious Complications
Post-operative hemorrhage requiring surgical intervention
Deep wound infection potentially requiring revision surgery
Need for revision to a higher amputation level (5-15%)
Deep vein thrombosis (blood clot) or pulmonary embolism
Persistent pain syndromes resistant to treatment
Prosthetic-related skin breakdown
Joint contractures limiting prosthetic use
Significant psychological adjustment difficulties or depression
Phantom limb pain that significantly impacts quality of life
Wound healing failure requiring surgical revision
Complex regional pain syndrome
Muscle imbalance leading to residual limb deformity
Arterial insufficiency in the residual limb
For diabetes-related amputations, progression requiring higher-level amputation
When to Seek Immediate Medical Attention
Excessive bleeding from the surgical site
Sudden increase in pain, swelling, redness, or warmth in the residual limb
Fever over 101°F (38.3°C)
Foul-smelling drainage from the incision
Opening of the surgical wound
Unusual or severe pain not controlled by prescribed medication
Calf pain, swelling, or tenderness in the remaining leg (potential blood clot)
Chest pain or sudden shortness of breath
New numbness or tingling in the residual limb
Any drainage or opening along the suture line
Significant change in color or temperature of the residual limb
Fall onto the residual limb or trauma to the surgical site
Sudden inability to bend or straighten a joint that was previously mobile
Signs of skin breakdown where the prosthesis contacts the skin
Prosthesis no longer fitting properly causing pain or skin issues
From your first consultation through your complete recovery, we provide:
Thorough evaluation and explanation of your condition
Clear discussion of all treatment options, including non-surgical alternatives when appropriate
Detailed pre-operative instructions to help you prepare
Compassionate care during your hospital stay or outpatient procedure
Comprehensive follow-up care and support during recovery
Ongoing availability to address questions or concerns
We understand that facing head and neck surgery can be intimidating, but you don't have to navigate this journey alone. Our team is committed to providing expert care with a personal touch, ensuring you feel supported, informed, and confident every step of the way.
Your health and wellbeing are our highest priorities, and we're honored to be part of your care team.
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All our laparoscopic procedures are performed by our highly trained surgical team using state-of-the-art equipment and techniques.
We're committed to providing you with the most advanced, minimally invasive options because we believe you deserve:
Less pain after surgery
Shorter hospital stays
Faster return to work and activities you enjoy
Smaller, less visible scars
Lower risk of complications
Better overall outcomes
Dr. Richard Nguyen is a board-certified General Surgeon with over 20 years of surgical expertise and fellowship training in Minimally Invasive and Bariatric Surgery from Vanderbilt University. Since establishing his practice in San Jose in 2007, he has pioneered innovative surgical techniques, including single-incision laparoscopic procedures and mastery of the da Vinci Robotic Surgical System. Beyond his acclaimed bariatric surgery practice, he has earned national recognition for his specialized expertise in both non-mesh and advanced mesh hernia repairs, while also serving as a critical approach surgeon for anterior spine access procedures. Dr. Nguyen combines technical precision with personalized care across multiple premier facilities throughout the South Bay Area.
I would refer Doctor Nguyen to anyone, in fact I have and they have all had the same experience as me. He is truly great. I owe all my success to Doctor Nguyen and I thank him for all the work he has done for me and continues to do so. He is extremely amazing, and I am very grateful to him.
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At 50, I now have a life I had only dreamed of a year before. My body tells me if I am done eating. This surgery is a tool that I have used to the fullest. It is not an easy way out. It still took work. But I honestly know that I would not be living this amazing new life if I didn’t step forward to embrace this life-saving surgery.
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Dr. Nguyen has changed my life completely. I feel so much better and I also feel like I’ve got control of my life again…I had high blood pressure, diabetes and cholesterol. I took at least 5 different medications for the past 30 years. NOW, after surgery I take no medications only vitamins!
Wondering which surgical procedure might be right for your condition? We're here to help you understand your treatment options and develop a personalized surgical plan. Contact our office today to schedule a consultation.
Your path to improved health may be more achievable than you think—with advanced surgical techniques leading to faster recovery, reduced complications, and a significantly enhanced quality of life.