Pelvic limb amputations are palliative salvage procedures used for end-stage diseases, including complex fractures or chronic complications with previous repairs, appendicular neoplasia, extensive trauma, chronic nonhealing wounds, or appendicular neuropathies (eg, brachial plexus avulsion). Some amputations are necessary due to the pet owner’s financial constraints. However, surgeons are encouraged to exhaust all options prior to limb amputation while also educating owners about the risks, complications, and prognosis for each specific clinical case.
The midfemoral amputation technique protects male genitalia with favorable cosmesis but can cause a greater likelihood of muscle atrophy and pressure sores. Amputation by coxofemoral joint disarticulation, however, obviates the risk for delayed muscle atrophy and has favorable cosmesis. This procedure provides a predictable outcome and reduces the likelihood of pressure sore development, thereby improving postoperative recovery and at-home incision management as compared with the midfemoral technique.
Complete presurgical orthopedic and neurologic examinations are necessary. Dogs undergoing pelvic limb amputation adapt through increased tarsal range of motion in the contralateral limb, coupled with increased range of motion of the cervicothoracic and thoracolumbar vertebrae.1 It is important to explain to owners that, although amputations typically have a good prognosis, increased BCS negatively correlates with quality-of-life scores.2 Preoperative surgical preparation varies based on patient size, although the landmarks used are identical regardless of patient size (see Step 1). Owners should be informed that extensive removal of the patient’s hair coat prior to surgery is necessary and that regrowth will take some time.
Preoperative antibiotics (eg, cefazolin [22 mg/kg IV], ampicillin/sulbactam [30 mg/kg IV]) should be routinely administered at induction and every 90 minutes during surgery. However, because routine amputations are classified as clean procedures, postoperative antimicrobial stewardship should be considered before continuing antibiotics. In most cases, unless there is noticeable pyoderma surrounding the incision site, antibiotics are not necessary postoperatively. Preoperative epidurals, intraoperative perineural injections, liposomal encapsulated bupivacaine during closure, and/or placement of an indwelling pain-soaker catheter in the superficial tissues should be considered. Perioperative analgesics are necessary. Additional IV and oral analgesics should be administered during the postoperative period for 10 to 14 days depending on the patient’s comfort level. Injectable opioids (eg, morphine, methadone, fentanyl) can be administered immediately following surgery and later (next day following pain assessment) transitioned to oral NSAIDs for the duration of the recovery period.
Routine postoperative exercise restriction and incision care, including use of cold and warm compresses, are standard. NSAIDs, ancillary analgesics, and anxiolytics are routinely provided for at-home care.