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early strengthening begins sooner under supervision."},"final_result_months":{"min":6,"max":12,"unit":"months","qualifier":"Residual limb volume stabilizes and prosthetic gait training matures; depends on amputation level and healing."},"fly_home_after_days":{"min":10,"max":21,"unit":"days","qualifier":"After surgeon clearance of wound and thrombosis risk; later if infection or delayed healing."},"follow_up_visits":[{"purpose":"wound_check","after":{"min":7,"max":14,"unit":"days","qualifier":"Before discharge or travel home"},"requirement":"routine"},{"purpose":"suture_removal","after":{"min":10,"max":14,"unit":"days","qualifier":"Before flight home; may be done locally"},"requirement":"routine"},{"purpose":"rehabilitation","after":{"min":42,"max":90,"unit":"days","qualifier":"Prosthetic assessment once residual limb healed and shaped"},"requirement":"routine"},{"purpose":"assessment","after":{"min":14,"max":60,"unit":"days","qualifier":"For infection, poor healing or pain concerns"},"requirement":"conditional"}],"indications":["Irreversible limb ischemia (e.g., PAD, critical limb ischemia) not revascularizable","Severe infection (gangrene, necrotizing infection, osteomyelitis) not otherwise controllable","Severe trauma with non-salvageable limb","Malignant bone or soft-tissue tumors without limb-salvage option","Non-healing diabetic foot ulcers with deep infection or tissue loss","Painful, non-functional limb after nerve injury or failed reconstruction"],"main_risks":["Wound infection and delayed wound healing","Need for revision to a higher amputation level","Bleeding or hematoma","Phantom limb sensation and pain; residual limb pain or neuroma","Deep vein thrombosis and pulmonary embolism","Cardiovascular and other systemic perioperative complications, especially in vascular patients","Joint contractures and falls","Psychological adjustment issues, including depression"],"pain":"Postoperative pain is significant and is managed with multimodal analgesia, often including regional nerve blocks; phantom limb sensations or pain may develop afterward.","preparation":["Vascular and perfusion assessment","Blood tests including HbA1c and glucose control","Cardiac and anesthesia evaluation","Antibiotic treatment of infection as indicated","Review and adjust blood thinners","Fasting before surgery","Counseling and prosthetic rehabilitation planning","Optimize nutrition and stop smoking"],"recovery_timeline":[{"phase":"Days 0-3","description":"Hospital monitoring with multimodal pain control, dressing care and thrombosis prophylaxis.","restrictions":["No weight bearing on residual limb","Keep limb elevated per instruction"]},{"phase":"Days 4-14","description":"Early mobilization with wheelchair or walker, wound checks, physiotherapy and positioning to prevent contractures.","restrictions":["No prosthetic loading","Avoid prolonged knee flexion"]},{"phase":"Weeks 2-6","description":"Wound healing, suture removal, residual limb shrinker and desensitization, strengthening exercises.","restrictions":["Protect wound from trauma","No driving until cleared"]},{"phase":"Weeks 6-12","description":"Prosthetic casting and fitting, gait training begins once wound is healed.","restrictions":["Gradual prosthesis wear schedule"]},{"phase":"Months 3-12","description":"Residual limb matures, prosthesis adjusted, return to full activities and work.","restrictions":["Monitor skin for pressure sores"]}],"rehabilitation_days":{"min":60,"max":120,"unit":"days","qualifier":"Prosthetic fitting and gait training; depends on healing, amputation level and general fitness."},"result_longevity":"Amputation is permanent. Prosthetic components typically need replacement every 3-5 years, and socket refits are needed as the limb changes.","revision_rate_pct":{"min":10,"max":25,"unit":"percent","qualifier":"Reoperation or conversion to higher amputation level within 1 year; lower for traumatic cases."},"scars":"A permanent surgical scar at the residual limb is expected; its position and length depend on the level and flap design.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single definitive operation in the usual uncomplicated protocol."},"stages":[{"code":"amputation","label":"Definitive amputation and wound closure","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed on day of surgery"}}],"qualifier":"Staged guillotine approach adds a second closure operation in infected cases."},"success":{"metric":"Primary stump healing without higher-level revision","value":80,"unit":"percent","horizon":"6 months","population":"Adults with transtibial amputation for ischemia or infection","evidence_status":"limited"},"techniques":[{"name":"Digit or partial foot/hand amputation (e.g., toe, ray)","suits_whom":"Localized infection, gangrene or trauma confined to a digit or ray with adequate perfusion for healing","recovery":"Varies; generally shorter than major limb amputation, depending on wound healing"},{"name":"Transtibial (below-knee) amputation","suits_whom":"Disease or injury of the foot or distal leg when the knee can be preserved and perfusion allows healing","recovery":"Prolonged wound healing and prosthetic rehabilitation; timelines vary widely"},{"name":"Transfemoral (above-knee) amputation","suits_whom":"Extensive disease or injury above the knee-preserving level, or when lower-level healing is unlikely","recovery":"Longer rehabilitation with higher energy demand for prosthetic walking; timelines vary widely"},{"name":"Staged amputation (open guillotine followed by definitive closure)","suits_whom":"Severe infection or contamination requiring source control before closure","recovery":"Requires a second operation; overall recovery longer"}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":1,"max":3,"unit":"hours","qualifier":"Operating time for transtibial amputation; varies with level and complexity."},"initial_assessment_documents":["Photos of the affected limb","X-ray of the affected limb","Vascular Doppler or angiography report","Recent blood tests including HbA1c","Wound culture report (if available)","Surgical or trauma reports"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"Single operation; stay 10-21 days including wound check. Staged amputation needs a second operation. Prosthetic fitting follows at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check you will be fully assessed before a planned amputation, to identify the most suitable type","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Check a thorough medical examination of your heart and lungs is included before surgery","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"The assessment is likely to include a thorough medical examination to check your physical condition, such as your cardiovascular system (heart, blood and blood vessels) and your respiratory system (lungs and airways).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Check the doctor will assess the condition and function of your healthy limb","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"The doctor will also check the condition and function of your healthy limb.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Check whether a psychological assessment is included, to judge how you will cope and what support you need","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"It may also include a psychological assessment to determine how well you'll cope with the psychological and emotional impact of amputation, and whether you'll need additional support.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Check a prosthetist will advise you on the types of prosthetic limbs or devices available","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"A prosthetist (a specialist in prosthetic limbs) will advise you about the type and function of prosthetic limbs or other devices available.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Check whether your home, work and social surroundings will be assessed for changes you may need","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"There may be an assessment of your home, work and social environments to check if any changes will need to be made to help you cope.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C7","text":"Check that a discharge summary letter is provided to share with doctors continuing care","scope":"procedure","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"A discharge summary letter of your hospital care is provided to share with your GP and any visiting doctors.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"A planned amputation offered with no full assessment before surgery","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F2","text":"An offer promising a prosthetic limb for every patient","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Prosthetic limbs are not suitable for everyone who's had an amputation because an extensive course of physiotherapy and rehabilitation is required.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F3","text":"An offer describing recovery with no mention of rehabilitation","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Physical rehabilitation is an important part of the recovery process.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Pain that interferes with sleep or daily activities","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain","host":"my.clevelandclinic.org","quote":"Pain that interferes with sleep or daily activities.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Excessive swelling or bleeding","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21599-amputation","host":"my.clevelandclinic.org","quote":"With reduced resources for healing, wounds may be slow to close or may reopen, and you may have excessive swelling or bleeding.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Fever or skin discoloration in the residual limb","urgency":"contact_clinic","general":true,"source":{"url":"https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain","host":"my.clevelandclinic.org","quote":"Signs of infection, such as fever or skin discoloration in the residual limb.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Home doctor needs it to understand the hospital care given","document":"discharge summary letter","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"A discharge summary letter of your hospital care is provided to share with your GP and any visiting doctors.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T2","text":"Home doctor needs it to continue compression sock care","document":"compression sock instructions","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"You will receive written instructions on using the compression sock.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T3","text":"It identifies planned prosthetic and rehabilitation follow-up","document":"prosthetic appointment letter","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"You have an appointment at the Prosthetic Department to meet the prosthetic team and rehabilitation consultant.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T4","text":"It tells home doctors about planned post-discharge review","document":"follow-up appointment letter","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"You'll probably need to attend a follow-up appointment a few weeks after you leave hospital, to discuss how you're coping at home and whether you need additional help, support or equipment.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T5","text":"It documents rehabilitation arranged in the patient’s area","document":"physiotherapy referral","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"Physiotherapy is arranged in your area.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T6","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"ok","items":[{"id":"A1","text":"Your limb might be saved using advanced surgical techniques","name":"Limb salvage surgery","source":{"url":"https://my.clevelandclinic.org/health/procedures/21599-amputation","host":"my.clevelandclinic.org","quote":"In some cases, they might be able to attempt to save your limb using advanced surgical techniques.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200},"operation_id":null},{"id":"A2","text":"You want to preserve as much mobility as possible","name":"Rotationplasty","source":{"url":"https://my.clevelandclinic.org/health/procedures/rotationplasty","host":"my.clevelandclinic.org","quote":"Rotationplasty is one option when you need surgery to remove part of your upper leg but want to preserve as much mobility and durability as possible.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200},"operation_id":null}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"technique_details":{"status":"ok","items":[{"id":"digit","name":"Digit or partial foot/hand amputation (e.g., toe, ray)","how_it_works":{"text":"Surgeons remove damaged tissue while preserving healthy limb tissue","source":{"url":"https://my.clevelandclinic.org/health/procedures/21599-amputation","host":"my.clevelandclinic.org","quote":"During surgery, your surgeon will remove all diseased and damaged 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