• Surgical amputation of digits or limbs may be warranted in cases where disease cannot be treated by any other means.
• Common indications in reptiles include severe abscessation, septic arthritis, osteomyelitis Osteomyelitis, fractures with a poor fracture assessment score, traumatic injury and neoplasia.

Uses

• Amputation is most commonly used to treat severe abscessation and osteomyelitis . Reptiles lack many of the proteolytic enzymes to turn solid pus to liquid; as a result, pus is thick and does not drain. Treatment is aimed at removing the capsule which is often not possible in the distal limb Abscesses.
• Traumatic injuries are commonly seen in reptiles, particularly tortoises bitten by dogs .
• Some neoplastic conditions will require amputation to ensure complete surgical margins .
• Open or comminuted fractures that are unlikely to heal with conservative management or surgical repair, or those in which treatment has failed .

Advantages

• Amputation is a salvage procedure that may increase quality and length of life.
• In some cases, there may be no other options bar euthanasia.
• Early amputation may be more cost effective, particularly in cases where medical therapy or surgery stands a poor chance of success.
• Lizards and tortoises usually cope well when a digit or limb is removed but this depends on the species, location and weight of the animal.

Disadvantages

• The prognosis for function is dependent on the digit or limb removed, the weight and activity level of the animal and any comorbidities, particularly those affecting other joints or limbs. It is therefore essential to perform whole body radiography to assess the presence or absence of osteomyelitis in other areas.
• Hematogenous spread of infection is VERY common.
• In some cases, a heart murmur is audible indicating valvular endocarditis, a poor prognostic sign.
• Hindlimb amputation may interfere with copulation in female lizards.

Alternative techniques

• Medical management of septic arthritis, osteomyelitis and severe abscessation is an option however the prognosis with this alone is poor in many reptile patients.
• Fractures may be repaired or treated conservatively.

• Some neoplasms may be removable but closure of the wound and ensuring margins may be difficult.

Time required

Preparation

• 20-30 min to assemble required equipment, induce anesthesia and prepare surgical site.
• As with any anesthesia in reptiles, there must be adequate time to ensure the animal is at its preferred optimal temperature beforehand.

Procedure

• Variable depending on whether a digit or limb is removed.

Decision taking

Criteria for choosing test

• Severe abscessation.
• Radiographic evidence of osteomyelitis .
• Failure to respond to medical treatment.
• Significant mobility problems or discomfort caused by digit/limb.
• Confirmed malignant, invasive or non-resectable neoplasms.
• Fractures with a poor assessment score unlikely to respond to external coaptation or internal fixation.
• Limbs severely damaged or partially amputated due to trauma, particularly dog and cat bites.

Risk assessment

• Risk assessment broadly similar to that for general anesthesia in reptiles.
• Likely mobility and function post amputation should be considered for the individual patient. Size of patient is an important consideration with larger reptiles, eg large monitors or crocodilians, being poorer candidates for limb amputation.
• Hypovolemia, dehydration and hypothermia must be corrected. Pre-emptive analgesia Analgesia should be provided.
• Comorbidities and chronicity of disease should be taken into account.
• Basic bloods, including uric acid, TP and PCV, should be considered.