By leveraging his extensive experience and cutting-edge techniques, Dr. Chang ensures that every aspect of your recovery is meticulously managed, from the initial surgery to optimizing prosthetic fit and addressing any complications that may arise. Trust in Dr. Chang’s expertise to support you every step of the way and help you regain the mobility and independence you deserve.

Dr. Chang’s commitment goes beyond the surgical procedure. His goal is to achieve a functional lower extremity that allows you to return to a pain-free, pre-operative level of ambulation.

Welcome to Dr. Chang’s specialized practice, where we understand the profound impact of a major lower extremity amputation on your life. Whether your amputation is due to trauma, cancer, vascular disease, or chronic wounds, or if you’re struggling with complications from a prior amputation such as chronic pain, poor prosthetic fit, or persistent wounds, we are here to guide you through a transformative journey. Dr. Chang is renowned for his expertise with lower extremity amputations, having authored numerous influential articles and textbook chapters with his two mentors, Dr. Christopher Attinger and Dr. Grant Kleiber, both highly regarded international experts. His innovative techniques are tailored to address your unique needs, aiming to restore not just functionality but also your quality of life. 

Overview & Why Choose Dr. Chang

Lower Extremity Functional Amputation 

  • Acute Trauma with a Non-Salvageable Foot: If you’ve experienced a severe injury that has left your foot irreparably damaged and beyond salvage, a functional lower extremity amputation may be the most effective solution to restore pain-free mobility. 

  • Remote Trauma with Poor-Functioning Leg: For those who have sustained injuries in the past that have resulted in a foot or leg that functions poorly, or if you suffer from chronic pain or wounds that refuse to heal, a functional amputation may enable you to physically perform at a higher level, have less pain, and improve your quality of life. 

  • Cancer: In cases where cancer has affected the lower extremity, leading to significant damage or spread that compromises limb function and health, a functional amputation may be recommended to remove the affected tissue and facilitate a better prognosis.

  • Vascular Disease: If vascular disease has severely impaired blood flow, resulting in non-healing wounds, gangrene, or significant pain, amputation can be a crucial step towards pain relief and improved overall health by removing the affected limb.

  • Chronic Diabetes-Related Foot Wounds: Persistent diabetic foot ulcers or wounds that do not respond to treatment can lead to severe complications. Amputation may be necessary to prevent the spread of infection and restore functional mobility.

  • Prior Amputation with Functional Issues: If you’ve previously undergone an amputation but are facing ongoing complications such as chronic pain, poor prosthetic fit, or recurrent wounds, revising the amputation can help address these issues and improve your functionality. 

  • Realistic Expectations – Dr. Chang views surgery as a partnership between the patient and him. It is important trust and confidence go both ways. Together, we will discuss your goals and if we can reasonably achieve those goals based on your anatomy. 

Who Is a candidate?

  • Medical Evaluation – Dr. Chang will review your medical conditions, medications, and prior surgeries. Some patients may be referred to their primary care doctor or a specialist to ensure you are medically optimized for a safe surgery under general anesthesia and post-operative recovery. Some patients may be recommended to optimize certain parameters before proceeding with surgery. This may include weight loss, smoking cessation, nutrition optimization, resolution of an acute illness or condition, etc. 

  • Physical Examination – Dr. Chang will examine the affected extremity. This will involve assessing the quality and thickness of the skin and subcutaneous tissues, the muscle bulk and strength, your sensation, and the presence of any wounds and scars. If you have already had an amputation, Dr. Chang will assess for the quality of stump support and coverage, wounds, bursae (fluid pockets), focal areas of pain, symptomatic neuromas, and phantom limb pain. You will be examined for signs concerning for complex regional pain syndrome (CRPS).

  • Clinical Photographs – Clinical photos of your extremities may be taken.
 
  • Imaging Studies – X-rays will be obtained of the affected extremity to assess your bony anatomy. In select cases, typically revision cases, additional imaging such as a CT or MRI scan may be ordered.

  • Other Specialist Referrals – All patients are recommended to meet with the other critical multi-disciplinary specialists prior to undergoing surgery. These specialists include a regional pain specialist to help with peri-operative pain, a prosthetist, and a rehabilitation specialist.  

Pre-Operative

  • Overview – There are multiple levels of lower extremity amputations, meaning at what level the bones are cut, which determines how much of your native leg remains. In general, Dr. Chang preserves as much length as possible to maximize your ambulatory stability and power with a prosthetic. While the below-knee amputation is the most common and preferred, in some patient cases, that is not possible, and you will be recommended for a through-knee or above-knee amputation. 

  • Below-Knee Amputation (BKA) – The amputation occurs below the knee joint, so it preserves the knee joint and much of the leg's natural length.

  • Through-Knee Amputation (TKA) – The amputation is performed through the knee joint, which the entire femur and the attachments of many of your hip adductor muscles. 

  • Above-Knee Amputation (AKA) – The amputation occurs above the knee joint. 


Levels of Amputation

  • Preservation of Limb Length – Dr. Chang is committed to preserving as much of your native extremity as possible. This approach helps provide the most stability and power with your prosthetic limb. By retaining more of your natural limb, you will benefit from improved balance and a more effective transfer of energy during ambulation. 

  • Advanced Bone Contouring Techniques – Dr. Chang carefully sculpts and stabilizes the remaining leg bones to maximize long-term strength and stability of your leg and to prevent development of uncomfortable bony pressure points. 

  • Muscle and Tendon Repairs – Dr. Chang repairs and creates new insertion points for all the remaining muscles and tendons in your lower extremity to maximize strength when ambulating with a prosthetic and to minimize future stump atrophy.

  • Nerve Stabilization and Pain Management – Unfortunately, patients are at high risk for chronic pain from damage to the major nerves of the lower extremity after an amputation. Dr. Chang uses highly innovative and specialized techniques of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) to help reduce the likelihood of developing chronic pain.

Technique

  • Dressings and Incision Care – Your incisions will be closed with non-absorbable sutures and dressed with a compression wrap. You will have a surgical drain. You may gently cleanse any drainage and the surrounding skin with a warm, soapy wash cloth. If you have the ability to shower while sitting in a chair, you may do so beginning the day after surgery. You cannot bathe or swim until instructed to do so. 

  • Pain Management and Medications – Local anesthetic (numbing medication) will be injected at your surgical sites to minimize your immediate post-operative pain. You should take acetaminophen and an NSAID around-the-clock, according to instruction, for the first 7 days and then as-needed thereafter. You can purchase these over-thecounter. You will be given a small number of low-dose narcotic pain medications for breakthrough pain only for the first 3-5 days. You will be started on special nerve-pain medications that you will take at least until 6 months after surgery. 

  • Recovery Period – You will be admitted to the hospital after surgery for pain control and to work with inpatient physical therapists. The physical therapists will help determine whether you are able and safe to return home after the hospital or if you would benefit from inpatient physical rehabilitation. Your drain will be removed at your first postoperative appointment at 1-2 weeks. Your sutures will be removed at 3-4 weeks. You will be fit with a prosthetic and allowed to start ambulating at 6-8 weeks. 

  • Follow-Up Visits – If you have any urgent concerns, you may call the office at any time. Otherwise, expect follow-up visits at 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, and 1 year.


Post-Operative

  • Chronic Pain – Studies show that up to 50% of patients with lower extremity amputations will have some degree of chronic pain. With proper use of advanced techniques, we can minimize that probability and/or make the pain you experience infrequent and mild. It is rare for a patient with a major amputation to be 100% pain free 100% of the time. 

  • Limited Ambulatory Ability – While the goal is to return you to your pre-amputation level of mobility, there is a chance that you will be disappointed with limitations in your physical functioning. Optimal post-amputation physical function is a product of surgical technique, a smooth healing process, patient dedication and commitment to physical therapy, and collaboration with the rehab specialists and prosthetists. 

  • Bone Healing Problems – Problems such as poor bone healing resulting in hardware complications or fractures, extra bone formation (heterotopic ossification), and painful bony prominences can occur.
 
  • Stump Wounds – Pressure wounds can develop on the stump from poor soft tissue padding or poor prosthetic fit. 

  • Bursae – Bursae are fluid collections that develop from shear forces creating inflammation and fluid to develop inside the body. 

  • Poor Scarring – Everyone scars differently. The final scar takes 6-12 months to mature. In rare cases, hypertrophic scars or keloids may form and may require secondary revision. 

  • Infection – Infections are managed with antibiotics. In severe cases, you may need an additional procedure.

  • Bleeding – Significant bleeding after surgery may require an urgent return to the operating room. Smaller collections of blood may be treated conservatively or managed with a small procedure in the office or the operative room. 

  • Need for Revision Surgery – For any number of reasons, a patient may need a revision of their amputation, which may include conversion to a higher level. 

Complications

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