Recovery after limb salvage surgery

What recovery involves

Limb salvage surgery does its main work in the operating room: it clears infection, removes dead tissue or infected bone, takes pressure off a spot that keeps breaking down, or rebuilds a collapsed foot. Recovery is how the foot heals around that change.

The weeks after depend on the operation. Surgery for a serious infection is sometimes done in stages, with a return to the operating room two to three days later to clean again or close the wound;⁠^[1] surgery for diabetic foot infection explains those steps. Antibiotics chosen from the tissue cultures often continue afterward, for a few days when all the infected bone was removed and for weeks when some infection remains.⁠^[6] Rebuilding a Charcot foot has its own, longer timeline; see Charcot reconstruction.

Getting ready is covered in preparing for limb salvage surgery. The Center for Lower Extremity Surgery explains recovery after any foot and ankle operation (external site).

Wound checks and dressings

After surgery we see you at our Lyndhurst, Paramus or Millburn office, usually every week or two, to look at the wound, measure it and adjust the plan. Dr. Efe Ozturk, a Foot and Ankle Surgeon, is board certified in wound care (FAPWH), so the doctor who operated on your foot also guides how the wound closes.

When the operation was for an infection, an incision on a diabetic foot often needs more time than the stitches do. In pooled data from two trials of surgery for diabetic foot infection, 76% of the 180 people whose wounds were stitched or stapled closed still had drainage, or skin not yet fully grown over the incision, when the stitches came out, typically 2–3 weeks after surgery. Those wounds took a median of 114 days to heal, against 28 for wounds that sealed on time, and more often became infected again or ended in an amputation within a year.⁠^[1] Low blood flow to the toes was more common in the wounds that came apart,⁠^[1] which is why we check circulation with noninvasive testing at our practice and work with a vascular specialist when it’s reduced. If your incision opens, read about surgical wounds that won’t heal.

At home, keep the dressing clean, dry and in place, and change it only the way you were shown. Guidelines advise against soaking the foot, which can leave the skin soft and fragile.⁠^[5]

When a wound needs it, we use negative-pressure wound therapy (a wound VAC), a dressing attached to a suction pump. In a Cochrane review, low-certainty evidence from wounds left after amputation surgery on the foot in people with diabetes suggested it may help more of them heal, and sooner, than moist dressings.⁠^[7] If an opening stays slow to close, we apply skin substitutes in the office or perform a skin graft for the wounds that need one. When a slow wound may benefit from hyperbaric oxygen therapy, we refer you to a center that provides it. Between visits, some people have a visiting nurse change dressings or look after the pump at home.

Keeping weight off the foot

On a numb foot, every step presses on the healing area, and you may not feel it. That’s why guidelines put taking pressure off at the center of healing a diabetic foot ulcer.⁠^[2] After surgery, that can mean no weight on the foot for a time, or walking only in a protective device.

If you’re in a total contact cast or another knee-high device you can’t take off, we fit it and show you how to get around safely. If your boot is removable, guidelines advise wearing it for all weight-bearing activity,⁠^[2] including the trip to the bathroom at night. Crutches, a walker, a knee scooter or a wheelchair fill the gaps. See offloading boots and footwear.

The guideline also suggests considering a lift in your other shoe to make walking in a boot more comfortable and steady.⁠^[2] Check both feet every day.

Preventing blood clots

Keeping a leg still raises the chance of a clot in the leg veins. In trials of adults whose injured leg was held in a cast or brace for at least a week, clots were found in 4.3% to 40% of those with no preventive treatment; daily blood-thinning injections lowered that rate, with minor bleeding the main side effect.⁠^[3] Whether you need a blood thinner depends on your own risks.

Preventing falls

In a review of four studies, people with a diabetic foot ulcer had 2.25 times the risk of falling of people with diabetes alone, though most studies had a high risk of bias.⁠^[4] Guidelines suggest a walking aid when a device affects your balance and a fall is likely.⁠^[2] Keep your device and walking aid beside the bed, and light the way to the bathroom.

Protect your heels in bed, too. Guidelines advise steps to prevent heel ulcers in anyone confined to bed, even briefly;⁠^[5] a pillow under the calf lets the heel float. See heel ulcers and pressure injuries.

Blood sugar, smoking and mood

In a study of 310 wounds in 183 people with diabetes, A1c (average blood sugar over 2–3 months) was the only factor measured that was linked to how fast wounds shrank: the higher the A1c, the slower the healing.⁠^[8] In a review of 140 studies across many kinds of surgery, smokers had about twice the odds of delayed healing or a wound coming apart compared with nonsmokers.⁠^[9] Stay smoke-free while you heal; our sister practice explains smoking, diabetes and healing (external site).

Weeks off your feet can wear on your mood. In a review of 11 studies, nearly half of people with a diabetic foot ulcer had signs of depression.⁠^[10] If you feel low, tell us or your primary care doctor.

Back into shoes, and staying healed

Once you’ve healed, you move from the protective device to footwear in stages. For Charcot foot, guidelines advise building up walking and weight on the foot gradually once it has settled, because of the risk that it becomes active again.⁠^[5] If that foot turns warm, red or swollen again, call us the same day; see a red, hot, swollen foot.

After an ulcer on the sole heals, guidelines advise therapeutic footwear shown to relieve pressure while walking, and never again wearing the shoe that caused the ulcer.⁠^[5] We fit therapeutic shoes and custom inserts shaped to your foot. Ozturk Foot & Ankle has more on diabetic foot care and therapeutic shoes (external site).

Most people who have had a foot infection stay at high risk of new foot problems, so lifelong foot checks are advised.⁠^[6] With nerve damage or poor circulation plus a past ulcer, an amputation or end-stage kidney disease, the guideline suggests check-ups every 1–3 months, based on expert opinion.⁠^[5] See keeping your foot in remission and problems after partial foot amputation.

Risks and limits

Recovery doesn’t always run in a straight line. A wound can open, infection can return, and further surgery is sometimes needed; healing tends to be slower with poor blood flow or high blood sugar.⁠^[1,8] None of this is a reason to put off an operation your foot needs. It’s the reason recovery is planned as carefully as the surgery.

Questions to ask before you go home

• How much weight may I put on the foot, and in which device?
• How do I care for the dressing, and when may I shower?
• Do I need a blood thinner? How long will I take antibiotics?
• What shoes will I wear once I’m healed?

When to seek care

See us within a day or two for any foot wound that isn’t healing, especially if you have diabetes.