Amputation in Dogs

An Overview of Amputation in Dogs

Amputation is often recommended by veterinarians for treating certain cancers – most commonly soft tissue sarcomas and osteosarcoma. Depending on the location and type of cancer, combining amputation with chemotherapy and/or radiation may also be recommended.

The point of amputation is to remove the limb with cancer, but it’s also to provide pain relief. These tumor types can really hurt, and dogs feel much better when the source of pain is gone.

Amputation does not only occur in the legs. Sometimes amputation is used to treat cancers of the toes, tail, or even the jaw. Your veterinarian will discuss the specificr procedure your dog needs with you prior to surgery so you know what to expect. An extensive area will be shaved around the surgical site and, depending on the location, your dog may have a large incision.

If your dog is having an amputation, your veterinary team will go over the specific procedure and an estimate of the cost with you before surgery, but in general, this is what happens during surgery:

• On the day of your dog’s surgery, your veterinary team will confirm that your dog has fasted as recommended (usually a minimum of 6 hours prior to surgery), and they will perform a physical exam to ensure your dog is healthy enough for anesthesia. This is a good time to ask any last-minute questions and confirm how and when you should expect updates on your dog.
• An intravenous (IV) catheter will be placed to deliver fluids, anesthetic drugs, and pain medications before, during, and after surgery. Your dog’s vital signs and pain level will be regularly monitored during and after surgery with medications given as needed to keep her comfortable.
• Your dog will usually be hospitalized overnight for continued monitoring and pain management. When your dog is ready to go home, your veterinary team will give you post-operative care instructions that should include:
  • incision care
  • medications and pain management
  • things to watch out for (such as signs of infection or other complications)
  • how to manage your dog’s activity
  • how to aid your dog’s mobility if needed
  • when to schedule your next appointment

Common Amputation Locations Examples

Full limb amputations are the most common type of amputation performed on dogs with cancer, but there are other types and locations, too.

Full Limb Amputations

These may be performed to limit the spread of cancer, relieve pain, or improve mobility in patients with tumors in areas that hinder mobility, such as a tumor in the elbow or scapula (shoulder blade) area.

Full limb amputations can happen to both the front and rear legs. The most common approach to front limb amputation is known as scapulothoracic disarticulation.¹ This means that the entire leg is removed by cutting the muscles attaching the leg to the body to separate the scapula from the thorax (chest). This leaves plenty of tissue for closing the incision and once healed, leaves a smooth surface on the body where pressure sores are unlikely to develop.

For the hind limb, there are three options for amputation. The first, and perhaps the most common option, is to remove the entire leg by separating the head of the femur (thigh bone) from its attachment within the hip joint. This leaves the pelvis and surrounding musculature intact for padding but creates a slightly asymmetrical look to the hip area.¹

For cancers lower in the hind leg, a “high femur” amputation¹ is sometimes performed. In this procedure, the muscles of the thigh and the femur are cut just below the hip but leave the hip joint intact. This provides more padding for the pelvis when the dog is lying down and helps maintain symmetry of the area.¹

The third option for hind limb amputation involves removing part of the pelvis (hemipelvectomy) along with the rest of the leg. This procedure is uncommon and is usually only considered for cancers involving the hip joint and/or pelvis.¹

Partial Limb Amputation

Partial limb amputation and prosthetic use is an option for some patients, but these are uncommon because the remaining portion of the limb often gets injured with normal daily activities,¹ resulting in chronic problems with the stump. Successful management of a stump and prosthetic requires meticulous care, and most dogs adjust more quickly to three legs than they do a prosthetic.

Digit Amputation

Digit (toe) amputation is often used for dogs with cancers affecting the toe or nail. Most dogs adjust surprisingly fast to having fewer toes, even with amputation of more than one toe. There are several different approaches to toe amputations, but most surgeons prefer to remove the entire toe by separating it at the 3rd “knuckle” joint (metacarpophalangeal joint or metatarsophalangeal joint) where the toe meets the 1st bone in the paw.⁵

Jaw Amputation

Sometimes invasive oral tumors, such as melanoma, require removal of a portion of one of the jaw bones. These are called maxillectomy (upper jaw) or mandibulectomy (lower jaw) and vary in their extent and approach depending on the area affected and size of the tumor.⁷

Tail Amputation

Skin, soft tissue, and bone tumors can also occur along the tail. Amputation is often recommended for these malignant tumors in order to get wide enough margins and have enough skin to appropriately close the incision.⁶

Why Your Veterinarian Is Recommending Amputation for Your Dog

Amputation is a first-line treatment for certain cancers and is recommended for a variety of reasons.

Amputation may be recommended for pain relief. For example, cancers that invade the bone are usually painful, so amputating the affected bone can provide excellent pain relief for your dog.

Amputation may also be recommended for cancers in areas that impede movement or interfere with eating, such as oral tumors.

Depending on the type and stage of cancer, amputation may be recommended in combination with chemotherapy and/or radiation.

Sometimes amputation is curative, such as with peripheral odontogenic fibromas⁸ or low-grade soft-tissue sarcomas⁹ on the limbs or tail.

While removing a leg or part of the jaw may seem drastic, surgical pain is generally temporary. Once the incision heals, the dog will no longer have pain from the tumor and should have an improved quality of life.

Dog Cancers That Might Need Amputation

Osteosarcoma, or bone cancer, is the most common bone tumor in dogs, but other tumor types may also require amputation.

Osteosarcoma

Osteosarcoma most often occurs in one of the legs.⁴ Full-limb amputation is a first-line treatment for osteosarcoma and is recommended both for reducing pain and to prevent further destruction of bone by the tumor.⁴ Bones affected by osteosarcoma are weak and can fracture from normal activity, so even if other treatment is not being pursued, amputation may be recommended to reduce pain and prevent the possibility of a pathologic fracture.

Because osteosarcoma spreads aggressively, amputation is not curative but can greatly improve your dog’s comfort level, thus enhancing quality of life and delaying euthanasia for several months.

Soft tissue sarcomas

Soft tissue sarcomas are a variety of tumors with similar behaviors that arise from connective tissues.⁹ Surgery is the treatment of choice for these, but because they are often invasive to surrounding tissues, wide surgical margins are needed to prevent regrowth.¹⁰ On the legs, paws, or tail, this may only be possible with amputation.

For low-grade soft tissue sarcomas, surgical removal of the mass can be curative, and for higher-grade tumors, the survival time after amputation is approximately 12 months.⁹

Oral tumors

In dogs, malignant melanoma, squamous cell sarcoma, and fibrosarcoma are the most common malignant tumors of the mouth.⁹ Surgery is a first-line treatment for these. Sometimes only soft tissues are removed, but, depending on location and extent, a partial amputation of the upper or lower jaw may also considered for oral tumors.²

Peripheral odontogenic fibroma is another common oral tumor that is benign but locally invasive. Removing the tumor, the affected teeth, and the underlying bone with appropriate margins is generally considered curative, as there is virtually no recurrence.⁸ Left alone, however, these will continue to grow slowly and further damage the teeth and jaw bones.

Digital tumors

Squamous cell carcinoma and malignant melanoma are the most common digital (toe) tumors in dogs, though soft tissue sarcoma, mast cell tumors, osteosarcoma, round cell carcinoma, and adenocarcinoma have been reported.¹¹ Amputation of the affected toes is usually recommended though short-term complications are common.

This is because there is less loose tissue in the paws, so there may be more tension on the incision, making it more likely to re-open and ultimately delay healing times.⁵ Despite this, however, dogs usually recover well, and long-term complications are rare.¹²

How to Get the Best Results for Your Dog

For most of the malignant cancers requiring an amputation, follow-up therapy with chemotherapy, radiation, and/or immunotherapy may be recommended to have the best outcome and longest survival times. This will vary depending on your dog’s caner type, location, and grade, and should be discussed with your veterinary team prior to surgery.

You should also discuss the expected outcome and potential complications with your veterinary team. Ask what you need to prepare for when your dog comes home after surgery and take steps to set yourself and your dog up for success.

For example, if your dog is having a limb amputation, it will take some time for her to adjust to having three legs. Getting her used to any mobility aids (harnesses, slings, ramps, etc.) before surgery can help with using them effectively after surgery when they are really needed.

A consultation with a rehabilitation veterinarian before surgery may be especially beneficial for helping you figure out how you can best help your dog after surgery. They can help you choose the assistive devices that will work best for you and your dog, and help you plan how to manage the home environment to keep your dog safe and comfortable while she recovers.

If your dog is on any medications or supplements, check with your veterinary team to see if these should be given or discontinued before surgery.

It is also important to talk with your family to ensure everyone understands their roles in your pet’s surgical recovery. If there are children in the house, make sure they know that they may not be able to play with the dog in the same way they are used to.

Home Care After Your Dog’s Amputation

Make sure the entire family understands the surgical recovery process and how it will affect daily life. Most dogs will be kept in the hospital for at least one night for observation and continued pain management. When your dog is ready to go home, a member of your veterinary team will go over instructions with you regarding home care and recovery.

Be sure to give all medications, especially antibiotics and pain medications as directed. If your dog is getting sick from any of her medications, talk to your veterinary team immediately to see if different medications are needed.

Your dog will be sent home with an e-collar – be sure this is always kept on until your veterinary team instructs otherwise (usually until after suture or staple removal). Even a couple of minutes of licking or chewing on an incision can damage it or introduce infection.

Once you are home, your dog’s activity will need to be restricted at least until the incision has healed and staples or sutures are removed. Creating a pen or using a small, quiet area you can block off as a “recovery room” will help restrict activity and encourage your dog to rest and heal.

Easy access to food and water will also be important. Elevated bowls may be helpful, especially for dogs with limb amputations as their balance will be different than before surgery.

Be prepared for any needed diet changes. For amputations of the upper or lower jaw, your dog may need a softer diet for a few days. Gastrointestinal upset is also common after anesthesia, so a bland diet (such as boiled chicken and rice) may be needed to manage any nausea, vomiting, diarrhea or constipation.

Be prepared to clean up messes. Sometimes dogs are incontinent for a few days after anesthesia, or your dog may be hesitant to go outside to eliminate. Cleaning supplies, waterless shampoo and/or wipes may be necessary to keep your dog clean and comfortable for the first few days she is home.

Mobility aids may be necessary to help your dog move around after surgery. For limb and toe amputations, stairs and slippery floors should be avoided until your dog is fully healed and steady on her feet. If it is necessary for your dog to walk on slippery floors or go up and down stairs, you should assist her at all times until she is fully healed. A Help ‘Em Up Harness™ or a sling made from a towel or thick scarf can help support her weight and prevent a fall. Ramps are another helpful option for navigating a few stairs and getting in and out of your car. These assistive devices will be especially important if your dog has concurrent issues that affect mobility, such as neurologic disease or arthritis.

The surgery site should be kept clean and dry, and bathing or swimming should be avoided until the dog has a re-check and suture or staple removal. This usually happens around 10-14 days after surgery. If you have a dog that needs regular bathing or grooming, plan a thorough grooming before your dog’s surgery so that her coat won’t require as much care during the recovery period.

Surprisingly, most dogs adjust quickly to moving around on three legs or eating with part of their jaw removed and most dogs return to many of their normal activities without issue.

Follow-Up Appointments After Amputation

Follow-up appointments with your veterinary team will be important to monitor healing and help plan radiotherapy or chemotherapy if it is recommended. The interval between rechecks will vary based on the type of procedure performed, how your dog’s recovery is going, and the veterinarian’s preferences. Typically sutures or staples will be removed at 10-14 days after surgery, and if there are no complications or concerns, this may be your first follow-up after surgery.

Physical rehabilitation appointments for dogs undergoing limb amputations may be scheduled 1-3 times per week depending on your dog’s needs.

When to Not Use Dog Amputation

Though most dogs recover very well, amputation is not appropriate for all situations. The recovery period is a big commitment, and you should have a thorough discussion with your veterinarian about your expectations. Some cases where amputation may not be the best option include:

• If cancer has metastasized and amputation is unlikely to improve your dog’s quality of life. X-rays or a CT scan should be performed to get a thorough picture of your dog’s health before the decision to amputate is made.
• If your dog has other painful conditions or mobility problems, such as significant osteoarthritis or neurologic disease.
• If you have mobility problems or any issue that will hinder your ability to provide the needed post-operative care.

Where to Get an Amputation

Many general practice veterinarians can perform straightforward amputations, though they may not be equipped to handle the follow-up care that is needed. For example, your dog will likely need to be hospitalized overnight and maybe even several days after surgery, but many general practices do not have overnight care.

A veterinary surgical oncology team at your local specialty hospital or teaching hospital may be better equipped to manage your dog’s case. In addition to hospitalization, they will also be able to direct the other aspects of follow-up treatment including chemotherapy radiation, or any other specialty care that may be needed.

Many specialty hospitals also have doctors who are certified as veterinary pain practitioners (CVPP) and/or rehabilitation practitioners (CCRT or CCRP). Including these in your dog’s care can help to ensure a smooth recovery and the best healing plan that combines drug therapies, supplements, and physical rehabilitation modalities to manage pain and restore mobility.

Safety and Side Effects

No anesthesia or surgical procedure is completely safe, but steps can be taken to improve safety. Having the surgery performed by a board-certified surgeon at a specialty hospital with a board-certified anesthesiologist or veterinary technician specializing in anesthesia may improve safety. These experts see complex cases every day and may be better equipped to manage any complications that arise.

Possible side effects or complications during and after the procedure may include:

• Anesthetic complications such as low blood pressure, heart abnormalities, breathing abnormalities, or low body temperature
• Pain
• Infection of the surgery site
• Wound dehiscence (incision opening up)
• Excessive bleeding

After surgery, the incision should be checked regularly for any signs of dehiscence or infection. These include any increase in swelling, redness, pain, bleeding, or other discharge. A small amount of serosanguinous discharge (clear and yellowish with small amounts of blood) is normal.

Cost of Dog Amputation

Amputation is a costly endeavor with most surgeries (including biopsies and hospitalizations) costing between $2,000-$7,000. This will vary based on geographic location and type of practitioner performing the procedure (boarded surgical oncologist vs. general practitioner). There will likely be additional costs associated with follow-up treatments (chemotherapy, etc.), and physical rehabilitation.