Amputation of a lower limb: postoperative treatment and rehabilitation

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What is it about ?

About 18 in 100,000 people have a lower limb amputation. Amputation usually results from irreversible tissue damage caused by circulation problems (for example diabetes).

First treatment after amputation

The first treatment after amputation is done in the hospital. The first steps are to relieve pain, heal wounds and prevent blood clots from forming in the veins through physical therapy exercises and medication.

Avoid stiffness in the knee and hip joints. So lie down mainly on your side or on your stomach: these positions promote the extension of the joints. Also avoid supporting the hip and hollow of the knee in a flexed position. Joint stiffness in the flexed position prevents rehabilitation.

After the operation, the amputation stump is wrapped in compresses and a bandage to prevent swelling (edema). The swelling makes healing difficult. When the wound barely oozes, we switch to an elastic compression bandage. If possible, the person wears a cuff: this is a silicone stocking that helps shape the shape of the stump. This sleeve can, in a second phase, serve as a point of attachment to the prosthesis. To get used to it, the sleeve is gradually worn for longer and longer periods. If this accommodation is difficult, for example because of pain, it is possible to temporarily use a crutch or a walker in addition to adequate pain relief.

Re-education

A suitable exercise program will be started as quickly as possible, and preferably spread over several sessions per day. In the beginning, priority is given to extending the joints. This program also includes a series of exercises for learning to stand up, as well as balance and coordination exercises and training in daily activities (eg washing, dressing).

After discharge from the hospital, the person is followed in consultation by the doctor specializing in rehabilitation and the prosthetist, among others. Then comes a prosthesis accommodation program, followed at the rehabilitation center. This program lasts an average of 4 weeks. During this rehabilitation phase, the person is followed by a multidisciplinary team made up of psychologists, social workers and sports therapists.

Cost

The mutual insurance company reimburses the prosthesis. A supplement may be requested depending on the material chosen (eg electrically controlled bionic prostheses).

Source

Foreign clinical practice guide ‘Amputation of a lower limb: postoperative treatment and rehabilitation’ (2000), updated 07/25/2017 – ebpracticenet

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