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higher in vascular patients."},"contraindications":["Hemodynamic instability not optimized for surgery","Uncontrolled sepsis without planned staged approach","Salvageable limb with feasible revascularization or reconstruction","Severe cardiopulmonary disease prohibiting anesthesia","Inadequate perfusion for healing at chosen level","Severe uncontrolled coagulopathy"],"days_in_clinic":{"min":7,"max":14,"unit":"nights","qualifier":"Inpatient stay for pain control, wound monitoring, early mobilization; longer with infection or complications."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":12,"max":24,"unit":"weeks","qualifier":"Structured exercise starts after wound healing and prosthetic fitting; early strengthening begins sooner under supervision."},"final_result_months":{"min":6,"max":12,"unit":"months","qualifier":"Residual limb volume stabilizes and prosthetic gait training matures; depends on amputation level and healing."},"fly_home_after_days":{"min":10,"max":21,"unit":"days","qualifier":"After surgeon clearance of wound and thrombosis risk; later if infection or delayed healing."},"follow_up_visits":[{"purpose":"wound_check","after":{"min":7,"max":14,"unit":"days","qualifier":"Before discharge or travel home"},"requirement":"routine"},{"purpose":"suture_removal","after":{"min":10,"max":14,"unit":"days","qualifier":"Before flight home; may be done locally"},"requirement":"routine"},{"purpose":"rehabilitation","after":{"min":42,"max":90,"unit":"days","qualifier":"Prosthetic assessment once residual limb healed and shaped"},"requirement":"routine"},{"purpose":"assessment","after":{"min":14,"max":60,"unit":"days","qualifier":"For infection, poor healing or pain concerns"},"requirement":"conditional"}],"indications":["Irreversible limb ischemia (e.g., PAD, critical limb ischemia) not revascularizable","Severe infection (gangrene, necrotizing infection, osteomyelitis) not otherwise controllable","Severe trauma with non-salvageable limb","Malignant bone or soft-tissue tumors without limb-salvage option","Non-healing diabetic foot ulcers with deep infection or tissue loss","Painful, non-functional limb after nerve injury or failed reconstruction"],"main_risks":["Wound infection and delayed wound healing","Need for revision to a higher amputation level","Bleeding or hematoma","Phantom limb sensation and pain; 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Staged amputation needs a second operation. Prosthetic fitting follows at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check you will be fully assessed before a planned amputation, to identify the most suitable type","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Check a thorough medical examination of your heart and lungs is included before surgery","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"The assessment is likely to include a thorough medical examination to check your physical condition, such as your cardiovascular system (heart, blood and blood vessels) and your respiratory system (lungs and airways).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Check the doctor will assess the condition and function of your healthy limb","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"The doctor will also check the condition and function of your healthy limb.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Check whether a psychological assessment is included, to judge how you will cope and what support you need","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"It may also include a psychological assessment to determine how well you'll cope with the psychological and emotional impact of amputation, and whether you'll need additional support.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Check a prosthetist will advise you on the 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care","scope":"procedure","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"A discharge summary letter of your hospital care is provided to share with your GP and any visiting doctors.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"A planned amputation offered with no full assessment before surgery","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F2","text":"An offer promising a prosthetic limb for every patient","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Prosthetic limbs are not suitable for everyone who's had an amputation because an extensive course of physiotherapy and rehabilitation is required.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F3","text":"An offer describing recovery with no mention of rehabilitation","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/amputation/","host":"nhs.uk","quote":"Physical rehabilitation is an important part of the recovery process.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Pain that interferes with sleep or daily activities","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain","host":"my.clevelandclinic.org","quote":"Pain that interferes with sleep or daily activities.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Excessive swelling or bleeding","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21599-amputation","host":"my.clevelandclinic.org","quote":"With reduced resources for healing, wounds may be slow to close or may reopen, and you may have excessive swelling or bleeding.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Fever or skin discoloration in the residual limb","urgency":"contact_clinic","general":true,"source":{"url":"https://my.clevelandclinic.org/health/diseases/12092-phantom-limb-pain","host":"my.clevelandclinic.org","quote":"Signs of infection, such as fever or skin discoloration in the residual limb.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Home doctor needs it to understand the hospital care given","document":"discharge summary letter","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"A discharge summary letter of your hospital care is provided to share with your GP and any visiting doctors.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T2","text":"Home doctor needs it to continue compression sock care","document":"compression sock instructions","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"You will receive written instructions on using the compression sock.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T3","text":"It identifies planned prosthetic and rehabilitation follow-up","document":"prosthetic appointment letter","source":{"url":"https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/amputee-information-patients-families-following-lower-limb-amputation","host":"ncic.nhs.uk","quote":"You have an appointment at the Prosthetic Department to meet the prosthetic team and rehabilitation consultant.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T4","text":"It tells home doctors about planned post-discharge review","document":"follow-up appointment 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