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TimoPohjolainen
MikaMäättänen

Amputation of the Lower Limb: Postoperative Treatment and Rehabilitation

Essentials

  • Pain management, prevention of venous thrombosis and reduction of swelling in the stump are the principal goals in the acute phase.
  • Physiotherapy should be introduced as soon as tolerated in order to restore optimal functional capacity and mobility.
  • Plans must be made as regards suitable rehabilitation, equipment and adaptations to the patient's home.

Treatment immediately after surgery

  • Adequate pain management
  • Prophylaxis against venous thrombosis (drug treatment and physiotherapy)
  • Deep breathing exercises particularly for elderly patients (e.g. using a ”blow bottle” device)
  • The patient must avoid
    • supporting the hip and knee in a flexed position
    • sitting in the same position for a prolonged time and any other positions that contribute towards limb oedema.
  • When in bed the patient should also lie in the lateral and prone positions as far as possible (promotes joint extension).
  • In order to reduce swelling the use of compression bandages or an elasticated stockinette is started as early as possible. A vacuum splint also prevents oedema. It can already be applied in the operating theatre.
  • Stump-shaping bandaging should be started as soon as the stump tolerates mild pressure. Less pressure should be applied as the winding of the bandage proceeds upward.
  • The silicone liner socket acclimatisation period may be started as early as 5-10 days after surgery provided that the stump is healing well and normally. The time the silicone liner socket is used is gradually increased; bandaging is continued alongside.
  • The stump must be protected against trauma; haemorrhage will delay wound healing.
  • A peer support person can give practical help to the amputee in adapting to the new situation and in many practical things.

Exercises

  • These should be started as soon as possible and carried out several times a day.
  • Exercises to the residual limb 1-2 times a day; joint extension is particularly important
    • Lying in the lateral or prone position the stump is slowly stretched and extended back 10-15 times.
    • Standing up, the stump is stretched back as far as possible 10-15 times.
    • Extension exercises of the knee are performed when standing, sitting and lying down 10-15 times.
  • Other limbs and the trunk must also be exercised.
  • There are also exercises to practise standing up as well as exercises to be done in the standing position.
  • Balance and coordination exercises

Prosthesis fitting

  • The silicone liner acclimatisation period is continued until oedema subsides after which the patient is fitted for a socket to take the prosthesis.
  • The fitting of the prosthesis and its timing are assessed individually. It is possible to obtain a custom-fitted silicone socket as early as 3 weeks after surgery.
  • The prosthesis is taken into use under guidance, and the use is gradually increased.
  • Assistive devices are chosen based on moving ability; in the beginning usually a rollator, thereafter e.g. two forearm crutches, one forearm crutch and a walking stick.
  • A home visit by a physiotherapist and an occupational therapist is often needed in the evaluation of alteration work required at home and of the need of assistive devices.
  • If the fitting of the prosthesis is delayed, standing and gait training may be carried out with the aid of an early walking aid.

Follow-up and pain prophylaxis

  • Adequate analgesia should be provided both before and after the amputation.
  • Weight management is important.
  • The weight-bearing ability of the stump and the suitability of the prosthesis must be monitored.
  • Compression dressings, supporting stockinettes and silicone sleeves may be used against oedema formation.
  • The patient may be eligible for various medical and occupational rehabilitation programmes that are paid from public funds or by insurance.

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