What is an amputation?
Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. The amputated person is called an amputee.
What should we pay attention to after amputation?
- Pain management
- Wound care
- Education of stump protection
- Controlling residual limb volume changes
- Weight management
- Permanent prosthesis
Generally, 80% of amputees experience phantom sensation after extremity amputation. Postamputation pain can be isolated to the residual limb or can occur as phantom pain. Stump pain is felt in and around the incision following surgery.
Phantom limb pain
Phantom limb pain is a sensation experienced in the region of the body that is no longer present. This pain was once seen as a psychological phenomenon experienced after amputation, but today it is known that these sensations originate in the spinal cord and brain. Not everyone will experience phantom pain, and your doctor will talk to you about treatment options, including medication, physiotherapy, use of rest techniques, and other options.
The phantom sensation is different from phantom pain. Phantom sensations appear regularly immediately after the amputation process, and these are real, painless sensations heard after the body’s amputation process. Pain control is a prerequisite for moving to other rehabilitation activities. For the majority of these patients, this pain will gradually resolve with wound healing and appropriate treatment. Researchers report that acceptance of limb loss, stump massage, homogeneous pressure created by bandaging, early starting exercises, usage of a temporary prosthesis, and physical therapy is effective in relieving phantom pain.
Skin and Wound care
After the surgery wound, the care and maintenance of residual limbs are very important. Once sutures are removed the stump should be cleaned daily with warm soapy water and thoroughly dried with a soft towel. The mild massage applied to the stump will help both regulate the circulation, normalize the sense of skin, and psychologically help the patients to accept the stump. To prevent excessive scar formation and tissue adhesions at the wound, deeper massage should be done with small circular movements. Adherent scar tissue is an important cause of pain. However, as long as edema continues, it is necessary to avoid deep massage. When a person has diabetes or circulatory problems wounds can take longer to heal, which can increase the risk of infections and other complications developing. This group of prosthetic users or users who tend to have skin problems afterward should pay special attention to hygiene and may use products for stump care. When the prosthesis is applied for the first time, it is worn no more than 15-20 minutes 3-4 times a day. If no rash lasts more than five minutes when the prosthesis is removed and checked, the prosthesis can be worn for 1-2 hours. The skin should then be checked every two hours and after weight-bearing activities. Then, by increasing the time, the prosthesis is removed to ventilate the stump twice a day and to clean the stump and prosthesis.
Initial residual Stump compression
After the operation swelling of residual limb tissue is expected. This post-operative swelling (edema) is the main problem to deal with. Edema developing due to surgical intervention is a natural response of the body and normally resolves within 1-2 weeks. Compression therapy is applied to reduce edema and prepare the residual limb for fitting the prosthesis.Elastic bandages, compression socks, and temporary prostheses applied during this period. In edema, besides medical support, resting the stump above the heart level, Elastic bandages, Compressive bandage, and Silicone liner are recommended. Elastic bandage application is the traditional method used in edema treatment. It is applied primarily by healthcare personnel, then it is taught and transferred to the patient or relative.
Strengthening the muscles
The loose of a limb affects the individual’s mobility and ability to perform activities of daily living. Our objective of exercises in amputee rehabilitation is; to protect the range of motion, prevent contractures, improve the blood circulation of the stump, shape the stump, balance the muscle strength, prevent muscle weakness and increase cardiopulmonary functional capacity. Muscles are weakened due to pain, immobility, and factors that cause amputation. For this reason, muscles should be strengthened before proceeding to the prosthesis. The physiotherapist will show you the exercises that are appropriate for you to provide the best training. Exercise programs should be arranged according to the amputation level. Each exercise should be performed 10 times 2-3 times a day in the beginning. You should not hold the breath while exercising.
The purpose of rehabilitation is to help the amputee to gain independence at the highest level they can, with the most efficient gait possible. If the person has a below-knee amputation when the stump is in a relaxed position, the hip joint opens forward, outward, and sideways; the knee joint tends to bend. In this case, the knee should not be bend. If no precautions are taken, this situation settles in the joints (contracture occurs) and it makes the application of the prosthesis and walking difficult. To prevent this situation,‘correct positioning’ and regular physical exercises to be followed should be started by your physiotherapist from the first day.
Correct limb position
After a leg amputation, it is very important to keep your residual limb positioned correctly to prevent complications such as muscle contracture, to maintain a full range of motion in your remaining joints, and to promote good blood circulation. For below-knee amputations: When seated, always keep your residual limb supported and the knee straight. In a wheelchair you can use an “amputee board”, and on a regular chair use a second chair of the same height to support your residual limb. For both below-knee and above-knee amputations: Lying flat on your stomach stretches the muscles at the front of your hips, which can help combat the contractures that develop when seated for too long. Try to spend 15 to 20 minutes in this position several times per day. Resist the habit of putting your residual limb in a flexed (bent) position – for example, supporting it on the handle of a crutch, hanging it over the side of a bed, or keeping the knee joint flexed when sitting on a bed. If the knee or hip joint remains flexed for long periods, this can disturb blood circulation and cause muscle contracture. Resting your residual limb in an elevated position can also help reduce pain and swelling. Just remember to keep it straight, especially when resting it on something like a cushion, where it may inadvertently bend. A piece of foam cut to size and in the right shape works very well to elevated the residual limb while keeping it straight.
Purpose usage of temporary prostheses
- Temporary prostheses can be used immediately after surgery or as soon as the wound heals.
- Temporary prostheses provide a more effective residual limb shape after elastic bandage. At the same time, the user gets used to the prosthesis and takes the final shape inside the stump socket.
- Allows walking early.
- Most elderly patients can safely walk using their temporary prosthesis and crutches. Some people may return to work with these prostheses.
- The process of using temporary prosthetics for amputated people provides a positive motivation.
- It allows evaluating the problems that can be seen in the permanent prosthesis in advance.
- If phantom pain has occurred It helps to pass faster.