Losing a limb is traumatic. One patient refused to look at her amputated limb for weeks and only allowed the healthcare team to dress her wound if her leg was shielded from her sight with a blanket. Others are unable to accept the thought of an amputation and refuse treatment altogether. 

“Patients struggle most with the potential loss of independence after losing a limb, so their first instinct is to reject the operation,” says Dr Sadhana Chandrasekar, Senior Consultant and Vascular Surgeon at Tan Tock Seng Hospital (TTSH)’s General Surgery Department. “Many lose hope that they will ever be able to live a meaningful life again after amputation.”

Complications Resulting from Poor Diabetes Management

Limb amputations are usually necessary for patients with poorly-controlled diabetes. Severe diabetes causes damage to nerve and blood vessels, resulting in loss of feeling and poor circulation. Patients are also often unable to feel pain. This toxic combination leads to a high risk of untreated sores on their feet, which can get infected and eventually turn gangrenous. Dead tissue must then be removed to prevent further spread of infection and blood poisoning.

The Ministry of Health estimates that four amputation procedures are carried out daily in Singapore. According to research by the National Healthcare Group (NHG) Health Services and Outcomes Research (HSOR) department, Singapore has one of the highest rates of lower limb amputations due to diabetes, in the world.

Vascular surgeons only consider major amputations — removal of the leg above or below the knee — as a last resort after wound treatment or limb-salvage techniques are unsuccessful, says Dr Glenn Tan, Consultant for Vascular and Endovascular Surgery at TTSH. 

“Early detection and treatment are critical in preventing amputations. Unfortunately, most patients only come to the hospital as an emergency after their wounds become severely infected and sepsis has set in,” he explains.

In cases where an amputation is unavoidable, the healthcare team provides pre-operation counselling and psychological support. Doctors, physiotherapists and prosthetists/orthotists also help to map out potential rehabilitation plans based on the patient’s personal goals after an operation. 

“Having the rehabilitation team explain how we can help patients regain some mobility and independence gives them hope to push forward following their operations,” says Dr Chandrasekar.

Related: Diabetic Foot Care

A Collective Effort - Recovering from Limb Amputations

The effects of diabetes can take a toll on the mental wellbeing of diabetes patients

Post-operation patients are looked after by a multidisciplinary rehabilitation team which focuses on helping patients manage their diabetes more effectively, as well as improving their mobility.

The goal is to help patients regain some form of independence. Some disciplines involved in recovery include:

  • Vascular surgery
  • Podiatry
  • Reconstructive surgery
  • Prosthetics and Orthotics
  • Geriatric medicine
  • Care & Counselling
  • Orthopaedic Surgery
  • Occupational Therapy
  • Rehabilitation Medicine
  • Nutrition & Dietetics
  • Physiotherapy
  • Nursing

Patients who require prostheses will undergo training for strengthening, balance and mobility exercises. They must also learn to walk with their prosthetic limbs, and training can take up to eight physiotherapy sessions. 

“Depending on the extent of the amputation and the patient’s physical ability, it is possible to reintegrate into the community, or even return to work,” says Ms Rie Nagai, Senior Prosthetist/Orthotist at the TTSH Foot Care and Limb Design Centre. 

How far patients can go depends on their own motivation and social support from families or caregivers. Dr Chandrasekar cites the example of a patient who was “extremely positive” despite the prospect of losing her leg, as she had a very supportive husband.

“He immediately made plans to make their home wheelchair-friendly and was most encouraging during his wife’s rehabilitation journey.”

Caregivers are the primary companions who journey alongside patients in the recovery process. They provide wound care if patients are unable to do so, and physical assistance so they can move around, as well as emotional support. Caregivers are also taught to look out for signs of depression that may include emotional instability, unwillingness to communicate, worsening physical conditions, and a general sense of hopelessness or apathy towards medical conditions.

Community support can also help with the recovery process. Patients may consider joining the Amputee Support Group, founded by Ang Mo Kio-Thye Hua Kwan Hospital, Care and Counselling Department and Tan Tock Seng Hospital Rehabilitation Centre. Patients can find mutual support through activities, as well as the sharing of personal experiences and challenges. Eligible patients can also sign up with the Singapore Disability Sports Council to take part in sporting activities for amputees and disabled athletes.

Related: Stop and Reverse Pre-diabetes

Prevention — The Best Cure is Good Diabetes Management

Diabetes management is vital in controlling diabetes

Post-amputation rehabilitation is challenging but not impossible. However, experts say the best prevention is for diabetes patients to reduce their risk of amputations by controlling their conditions through sensible diet and lifestyle choices. “Awareness, ownership of lifestyle and prevention through screening can go a long way towards helping patients maintain their overall health,” says Dr Tan.

Download the HealthHub app on Google Play or Apple Store to access more health and wellness advice at your fingertips.

Read these next: