Post-amputation recovery
Take the right actions to set up your patient for a successful development back to mobility.
Take the right actions to set up your patient for a successful development back to mobility.
Helping your patient prepare for a prosthesis
Immediately after amputation, you and your patient can start taking steps to maximise their future mobility. The main goals of the acute postoperative phase include:
Avoiding muscle contractures
Reduce and control edema
Residual limb care
Overall muscle strengthening and mobilisation
Each one of these goals will help you set your patient up for a successful future prosthetic fitting. Let’s take a closer look at each one.
Avoiding muscle contractures
Post-amputation, one of the first critical goals of rehabilitation is to prevent contractures: painful, involuntary shortening, and stiffening of muscles, tendons, and ligaments.
As much as possible, the patient’s residual limb should be positioned with the joint extended to prevent shortening of the remaining muscles. Try the following exercises if possible:
Supine position: Take care of the full knee and hip extension in a lying position. The residual limb should never remain in a flexed position, such as lying on a cushion.
Prone position: If the overall health condition permits, we recommend positioning patients on their abdomen with the head turned to the healthy side. Advanced exercise: Lie in prone position and prop yourself up on your forearms (see on the picture).
Sitting in a wheelchair: When a patient with a below-knee amputation is sitting up in bed or in a wheelchair, make sure that the residual limb is placed on a residual limb support board.
Long periods of sitting should be avoided for all amputation levels. This can reduce the limb’s mobility and, in severe cases, impact the patient’s ability to control a prosthesis.
Reduce and Control edema
Immediately after surgery, the patient’s wound dressing will need to be changed frequently. But once their surgical wound has been stabilised, the next priority is compression therapy. The primary focus of this step is to reduce swelling in the residual limb, but it can also help encourage blood flow, reduce pain, promote healing, and move the patient a step closer to a prosthesis.
There are several different ways to approach compression therapy. The right one often depends on the patient’s amputation level, the condition of their surgical wound, and your own clinical experience and comfort with various compression techniques.
Several different methods can be used to administer compression therapy that effectively reduces swelling:
Compression bandages enable a patient’s compression to be adjusted and individualised throughout the day by re-wrapping the residual limb. This method is more time-consuming and should only be performed by experienced personnel, as blood circulation can be disturbed if a bandage is too tight.
Compression socks are available in various sizes and two different compression classes. They are usually faster to apply than a compression bandage.
Compression liners are easy and quick to use, so patients can often apply one themselves with your guidance. The silicone material also has a scar-softening effect, while the liners themselves can be reprocessed and used for multiple patients.
If you opt to use a liner:
You may notice an increase in perspiration inside the liner at first. This typically tapers off over time.
Verify that there’s no air between the end of the liner and the patient’s residual limb. This will help ensure that the liner is applying consistent, even compression.
Prevent skin irritation by cleaning the liner regularly and applying Ottobock Procomfort Gel to the skin at the upper edge of the device.
How much compression is enough? The patient’s skin colour and temperature are typically a good indication. Their compression bandage or liner should be removed occasionally to check the residual limb for any circulation issues or reduced sensitivity. This is particularly important for elderly patients who may have circulation-related comorbidities.
Residual limb care
Protecting your patient’s skin
Some patients may develop rough, scaly, irritated skin around their surgical scar. To prevent this, consider having your patients:
Wash their residual limb morning and evening with water and a mild soap like Ottobock DermaClean.
Pat dry the skin each time and apply a moisturising cream.
You may also want to consider having your patient use a product specially formulated for the care of severely stressed skin like that on a surgical scar:
Ottobock DermaPrevent covers the skin with a protective film that helps prevent chafing and keeps the skin soft and supple.
Ottobock DermaRepair also helps protect and relieve the sensitive skin around a surgical scar.
Using a compression liner can be helpful too, as the silicone material often has a scar-softening effect.
Managing surgical scars
For most patients, the surgical wound on their residual limb generally closes in 3-4 weeks and starts to form a scar. But even once the outside of the wound has healed, the underlying scar tissue may take up to 18 months to fully heal.
During that time, caring for the patient’s developing scar is a key step in preparing them for a prosthesis:
Cleaning, massaging, and moisturising their scar will be an important daily task for your patient. Keeping their skin soft and flexible will make it easier and more comfortable to use a prosthesis.
Reducing scar sensitivity can also help your patient prepare for a prosthetic device. Have your patient gently rub their scar with a nubbed massage ball, a massage brush, or a rough towel or washcloth (in a distal to proximal motion).
When’s the right time to start these scar management steps? Before they begin, always check with the patient’s managing physician first to verify that the patient’s scar is sufficiently healed.
Overall muscle strengthening & mobilisation
After a lower leg amputation, torso, arm, and leg exercises can help your patient build the strength they need for the next steps in their rehabilitation:
Light weights and resistance bands can be used from a lying, sitting, or standing position (and should also include the residual limb as much as possible).
Practicing new movement patterns with their residual limb can also help your patient get familiar with how their leg function has changed post-amputation.
As their therapist, always ensure that your patient understands how to perform these exercises correctly, then regularly verify that they are doing so.
Watch on Ottobock YouTube
Physiotherapist Christoph and Feridun a prosthetic leg user guides you through practical exercises after amputation.
Share the Ottobock YouTube playlist Practical Information after Amputation with your team or your patients.
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