What Is a Guillotine Ankle Amputation?

Guillotine ankle amputation surgically cuts all of the tissue from the skin to bone.

A guillotine ankle amputation is an open type of amputation that involves surgical cutting of all of the tissue from the skin to bone at the level of the ankle. Because this surgery is performed without closure of skin, it is known as open surgery. A guillotine ankle amputation is performed to treat infection and remove drains from the surgical site. 

The residual leg (stump) closure or revision is carried out in a second surgical procedure.

A guillotine ankle amputation is indicated for the following conditions:

• Wet gas gangrene (severe bacterial infection of the affected tissue) of the feet
• Fulminant osteomyelitis (severe or sudden onset of infection in the bone)
• Foot complications due to diabetes mellitus
• Severe injury
• Cancerous tumor in the bone or muscle of the foot
• Severe burn in the foot
• Poor blood flow to the foot
• All these conditions prevent the normal functioning of the foot.

Before the surgery day, the patient needs to follow the following things:

• Enlist medical and medication history to the physician
• Refrain from alcohol and cigarette smoking
• Be physically and emotionally prepared for the surgery
• Maintain optimum health and nutritional and fluid balance
• Stop taking aspirin, ibuprofen, warfarin, or any other blood thinners
• Refrain from eating or drinking anything for 8 to 12 hours before the surgery

The amputation is performed under general or spinal anesthesia (numbs the body from the waist down). The patient is made to lie flat on the operation table. The patient is given antibiotics and blood thinners before the procedure.

During the procedure, the surgeon removes the diseased tissue and smoothens irregular areas of the bone. The physician closes off the blood vessels and nerves. The physician keeps the site open for several days. The surgeon performs stump closure or revision along with free drainage after several days.

The stump will be dressed and monitored for bleeding, edema, infection, or any blood flow restriction for three more days. The physician prescribes a pain reliever and antibiotics to prevent infection.

If the patient has a sensation that the amputated foot is still present (phantom limb sensation), the physician may prescribe medications. Counseling may be required for the grief that may follow from the loss of the body part.

The patient must begin physical therapy and gentle exercises soon after the surgery to strengthen the muscles and prevent joint tightening.

The wound generally heals in approximately four to eight weeks. An artificial foot may be fitted immediately or after some days depending on the condition of the patient.

Patients should follow these instructions in the hospital after the amputation for faster recovery:

• Strengthen the muscle with exercises
• Begin walking with a walking aid
• Keep the joints mobile
• Start moving around the bed and into the chair
• Try sitting or lying in different positions to prevent joint stiffness
• Control swelling around the amputated area
• Avoid putting excess weight on the stump until it is completely healed