What lies ahead for you after the amputation?
Directly after the operation, your recovery and the healing of the residual limb are the main concerns. Both are important so that you can begin with rehabilitation soon and a prosthesis can be fitted.
The following information is intended to prepare you for wearing a prosthesis. This makes it easier for you to use the prosthesis to best effect later on. Since we can’t address every individual case, we will only look at transhumeral amputations in the following.
Therapy begins shortly after the amputation. The wound is treated to prepare it for wearing a prosthesis. As soon as the surgical wound has healed properly, the actual prosthetic fitting and rehabilitation process can begin. In most cases, this will take up to six months.
Your own contribution becomes increasingly important in the course of therapy. Your rehabilitation team will support you. If you notice that certain measures listed here are not being implemented in your case, please ask your rehabilitation team. Your therapists can evaluate whether the measures would be useful for you.
Prepare your residual limb for wearing a prosthesis
The healing of your residual limb after the leg amputation forms the basis for the subsequent prosthetic fitting and is therefore especially important. In the hospital, the doctors treating you will continuously monitor and check the healing process, while the inpatient nursing staff looks after the daily treatment of your residual limb. In addition to wound treatment, this includes oedema and compression therapy, desensitising the skin, and scar care, among other things.
Oedema therapy
After the operation, the tissue around the residual limb will usually swell up at first. This swelling (oedema) is a normal reaction to the operation. It usually subsides after about one week. Only a loose wound dressing is applied until the sutures are removed. No pressure can be applied to the residual limb at first.
The circumference of the residual limb should be measured regularly to evaluate how the swelling is going down. The same measuring points always have to be used for this, and the results must be documented on measurement forms. If this isn’t done, the results are not comparable with each other and there is no way to tell whether the swelling is decreasing.
Correct positioning
Pronounced swelling of the residual limb for an extended period of time interferes with wound healing, and the time when a prosthesis can be fitted is delayed. You should assume a proper posture, even in the hospital bed, to prevent shortening and stiffening of the muscles and joints. Patients usually assume a comfortable and pain-free position at first, but experience has shown that this is not always optimal. As time progresses, the residual limb should lie in an extended position as far as possible. Permanently elevating it – for example, on a pillow – always has to be avoided, otherwise the muscles will shorten and the subsequent mobility of the residual limb is reduced.
Mobilisation
Move your residual limb several times a day. Doing this can prevent a loss of mobility in your joints. Early mobilisation is important because it activates the circulation and promotes balance. Get your therapist to show you movement exercises that are right for you at the respective time. The shoulder joint in particular has to be mobilised as early as possible; otherwise, it can become stiff. With a combination of correct positioning and movement, you can properly prepare your arm for wearing the prosthesis.
Compression therapy
Early compression therapy
After the operation, a wound dressing is applied and changed at regular intervals. Compression therapy begins after that, for example, with a compression bandage. Your doctor will determine the exact timing. The purpose of compression therapy is to reduce the residual limb oedema and prepare your residual limb for your subsequent prosthesis. Residual limb compression helps optimise the fitting of your prosthesis. Compression also promotes blood circulation in the residual limb. This reduces pain and promotes scar healing.
Compression bandage
A compression bandage makes it possible to readjust the pressure day by day or also in the course of a day. The pressure should be greatest at the end of the residual limb and gradually decrease towards the body. Elastic bandages secured with patches are used to wrap this bandage around the residual limb. Since this method requires some practice and experience, the bandage should either be applied by qualified personnel (Fig. 3), or the nursing staff should instruct you in the proper wrapping technique. It is important not to constrict the residual limb with the bandage, and it must not cause any pain.
Silicone liners
Silicone liners, on the other hand, are quick and easy to use. They are available in different ready-made sizes. To apply pressure as evenly as possible over the entire surface of the amputation site, it is crucial to ensure that no air is trapped at the end of the residual limb while putting on the liner! You might find that you perspire more inside the liner at first. This will correct itself after you wear it for some time. To avoid possible skin irritation, you can apply some Ottobock Derma Prevent to the skin in the area of the liner edge. Cleaning the silicone liner each time after wearing it is also very important. Please see the liner instructions for use for further information.
Further compression therapy
Once the volume of the residual limb is stable over an extended period of time – meaning the measured residual limb circumference is no longer decreasing – treatment with a prosthesis can begin. Compression should be continuously maintained until this time. Your treatment team will show you or your relatives how you can do this independently.
Training without the prosthesis
This preparatory training strengthens the torso musculature, including the abdomen and back, the sound arm and the legs. The residual limb should already be included in the exercises as well.
Stretching the muscles of the residual limb
The muscles and joints adjacent to the residual limb are also stretched early on. If actively moving the joints is difficult for you, passive support can be provided using a towel. Maintaining or regaining maximum mobility of your joints in all movement directions is important.
Improving the dexterity of the sound side
More or less intensive training of the sound side follows, depending on whether your dominant or non-dominant hand is affected. This training develops fine motor skills, dexterity and strength. You should practise challenging activities in particular, such as writing or brushing your teeth.
Training to develop the residual limb muscles
Before the fitting with a prosthesis, it is important to strengthen the residual limb muscles, sound arm, torso muscles and legs with preparatory training. This can improve the dexterity of the sound side in addition to maximising the mobility of your joints. This will make you that much more independent in activities of daily living later on.
Training to develop the torso muscles
Moving your upper body as much as possible is especially important after the amputation. Avoid pronounced twisting of the spine in doing so. The lack of balancing weight on one side can shift the centre of the body and therefore often change the statics of the spine as well. Exercises to strengthen the back are therefore recommended to prevent malpositions and pain.
Skin and scar care
In the hospital, the nursing staff and doctors took care of your residual limb by cleaning the wound and changing the bandages or dressings. In the rehabilitation phase, you now care for your residual limb, the scar and also your sound arm yourself. Being able to wear your prosthesis without problems requires ongoing, intensive care.
Desensitising the skin
The skin on the residual limb is often very sensitive after the amputation. You can take various steps to address this. Always use materials that are comfortable for you and work from the end of the residual limb towards the body.
Take a soft brush or a spiky massage ball, for example, and rub or tap the sensitive skin with it. This increases its resilience. You can also rub down the residual limb with a rougher towel or a washcloth.
Hygiene measures for the residual limb, such as daily washing with lukewarm water and unscented, skin-friendly soap, are very important. Ottobock care products can make cleaning easier for you.
Scar treatment
In most cases, the amputation wound closes within the first three to four weeks and forms a scar. But even if the scar appears to have healed well from the outside and only the colour of the scar tissue changes slightly from this point on, the overall scar healing process takes considerably longer. It takes about a year and a half for it to fully heal internally.
You should regularly moisturise your scar from the outset, since scar tissue has no capacity to moisturise itself. Unscented creams are recommended. This type of intensive care is important to keep the scar tissue soft and flexible as well as capable of bearing weight. This is essential in terms of being able to wear a prosthesis, because proper care can prevent pain on the residual limb due to movements in the prosthetic socket.