Postoperative therapy

Many experienced ergotherapists believe that far too little attention is paid to the residual limb. Physicians, therapists, technicians and patients must however take the post-operative phase of an amputation very seriously, since taking the right measures at the right time can often prevent complications and limitations later.

The question of how quickly one can begin with a prosthetic fitting after an amputation and the success of this fitting primarily depends on the early involvement of all participants.

Edema

The development of edema is a problem that is frequently underestimated in the post-operative fitting.  This develops on account of the fact that lymph liquid, which was previously carried out via the healthy lymph system, now collects in tissue openings. An edema is normally an unavoidable reaction to an operative, traumatic event and usually recedes after about a week. There are however post-operative cases where longer, non-receding edemas develop that lead to delays in the next stage of the prosthetic fitting.

A problem- free healing of the wound in the post-operative phase requires measures that prevent the continuation of edema or at least limit it. This includes not only systematic medical monitoring of the healing process after the operation, but also the correct handling of the residual limb.

The lymph liquid, for example, will drain well if the residual limb is elevated above the height of the heart. Additionally, specially trained therapists should drain off the lymph liquid daily in the post-operative phase. To determine the success of the treatment process and to increase motivation, residual limb measurements should be continuously taken and the results written down on measurement forms. Physicians, physiotherapists and ergotherapists receive recommendations on atraumatic treatment methods suited for edematous tissue.

Aggressive, manual stretching of the tissue on the residual limb should be avoided under all circumstances in edema therapy. This can lead to microtraumas that can in turn cause edema. Adequate pain therapy is also important to prevent the patient from thinking that a prosthetic fitting will not be possible for fear of more pain.

Other Treatment Steps

Other treatments besides edema prophylaxis are also important in the post-operative phase. Of central importance is wound and scar care. Then comes the sensitization of the residual limb and the desensitization of the scar tissue. Furthermore, it is important that the joints adjacent to the amputation level are mobilized early on. Soon after the amputation, the patient should begin to practice using his or her remaining limbs for performing daily activities, particularly cleaning the body, so that he or she can manage without the prosthesis in emergency situations.

Please ask your therapist to work out an individual exercise program which will help you train at home! Compression bandages must be used to shape the residual limb from the start. The therapist will perform the wrapping with elastic bandages for every residual limb length. Later this can be done by the patient him/herself after prior instruction.

If a patient is not capable of doing the wrapping alone and no one else is present who can do this, an individual or ready-made silicone liner can also be used instead.