After the amputation

Immediately after the operation, the focus is on your recovery and healing of the residual limb. Both are important so that you can start rehabilitation soon and be fitted with a prosthesis.

Amputated patient is lying in a hospital bed and receiving instruction on residual limb care from a therapist.

What should you expect after an amputation?

After the amputation your residual limb will be treated with a special wound healing bandage. The main goal is quick healing of the wound caused by the operation and preparation of the residual limb for your future prosthesis.

The focus during the initial period after the operation is on three treatment goals: You should have little to no pain, your residual limb should be able to bear weight, and you should be able to move your residual limb optimally in all directions.

In order for all of this to succeed, it is important for you to have your doctor or physiotherapist show you a few important things right after the operation: correct positioning in bed so that the muscles and the joint adjacent to the residual limb don't retract or become stiff, regular respiratory exercises as well as light movement and mobility exercises. These measures allow you to contribute to the quick and easy fitting with a prosthesis in order to remain mobile and active.

Correct positioning

Immediately after the operation, you will probably not be able either to lie still for longer periods or to turn over in bed by yourself. Therefore, have the nursing staff help you shift position several times a day. This change of position is important, since it allows you to ensure the most pain-free position and helps you prevent bedsores. In addition, correct posture is a decisive factor for your mobility.

Wound healing of the residual limb

When you wake up from the anesthetic, your leg will typically already be treated with simple bandages or a plaster cast with a small hose leading out of it. This hose was laid into the wound during the operation so that wound seepage and blood can flow out of the wound. This so-called drainage will be removed from the wound again during the healing process.

In most cases the amputation wound closes and forms a scar within the first three to four weeks. But even if the scar looks like it has healed well from the outside and only the color of the scar tissue is changing slightly, complete healing of the scar will take significantly longer. It takes about one and a half years until it has healed completely on the inside as well.

During this time intensive care (compression therapy and creams) are enormously important so that the scar tissue remains soft and pliable and at the same time develops the ability to bear weight. This is necessary in order to allow for wearing of a prosthesis.

Initial compression of the residual limb

After the operation, the tissue on the residual limb normally swells initially. This swelling (edema) is a normal reaction to the operation. It normally subsides after about a week.

Shortly after the operation, pressure is applied over a large area of your residual limb with the aid of elastic bandages, compression socks or other aids. The goal of this therapy is to reduce the residual limb edema and to optimize the residual limb for fitting of your prosthesis later on. This is important because a large residual limb edema would cause wound healing to take longer, and it would also take longer for the residual limb to take its final form so that a prosthesis can be fitted. In addition, compression aids circulation in the residual limb. This reduces the amount of pain and results in improved healing of the scar.

Which type of residual limb treatment is suitable for you – whether with elastic bandages, bandages, compression socks or a silicone liner – depends on the surgical technique, the amputation level, the condition of the wound and the personal experience of your treatment team. The optimal method will be selected for you.

Patient with a transtibial amputation is lying on a hospital bed with a bandaged residual limb in an extended position.
A nurse bandages the residual limb of a patient with a transtibial amputation.
A man with a transfemoral amputation trains his trunk together with his therapist.
Patient with a transfemoral amputation is standing beside the hospital bed and is being supported by the therapist in balancing exercises.
A patient fitted with an interim prosthesis standing between the parallel bars.


Exercises

In order for your body to be well prepared for the next treatment steps and so that you remain mobile, exercises to strengthen the trunk, arm, and leg muscles are highly recommended. Have your physiotherapist show you exercises which support your recovery and also train the joints near the amputation location as much as possible. The exercises can be performed with light weights and thera-bands, both while lying down and while sitting or standing. The residual limb should also be included in the exercises.

These exercises allow you to prevent the muscles and tissue from becoming stiff. Become familiar with movement sequences to which you will initially not be accustomed with the amputated leg. Your physiotherapist should show you exercises and check whether you are performing them correctly. They can advise you on the right exercises at the respective times.

Mobility training

Now you can work on your mobility training. Initially, you will probably still find it difficult to sit up in bed by yourself and to move to a wheelchair. But with a bit of practice you will master this quickly. Your physiotherapist should also give you precise instructions here. Straps or handles which you can use as aids are often attached to the bed as well. Soon you will get up for the first time. Since the familiar counterbalancing weight of the amputated body part is missing, you should be prepared for initial balancing problems. After a leg amputation, a walker or walking aids can initially help you maintain your balance.

Immediate and early fitting

In some cases, an initial prosthesis can already be fitted a short time after the amputation. With such an immediate fitting, some weight can be applied to the residual limb early on and the first walking exercises can be started. The immediate fitting usually takes place about ten days after the amputation. However, this type of prosthesis is not suited to all amputations. Your doctor, physiotherapist, and prosthetist will decide together if this is an option for you. If such an early fitting is possible for you, you will receive a new prosthesis after a few weeks: a so-called interim prosthesis which your prosthetist fits to you. It is suited to initial walking and standing exercises.

Compression Therapy

After the operation, the tissue on the residual limb normally swells at first. This swelling (edema) is a normal reaction to the operation. It can be reduced by applying pressure over a large area.

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