What to Expect After Amputation
It is normal to have questions and concerns about your amputation. In addition to the information that is on this web site, our office has put together a packet of information, literature and resources that we will deliver to you and your family free of charge. Our professional staff is available to come and answer all of our questions while giving you some idea of what to expect in the coming weeks. Feel free to contact our office to schedule a free consultation to discuss any concerns and questions you may have.
The staff at Treasure State Orthotics and Prosthetics is here to work with amputees through each stage of their prosthetic journey. We are available to meet with established patients, patients who are starting out as new amputees, or people dealing with unsatisfactory results from other prosthetic providers. Our staff has extensive experience and expertise in dealing with all levels of amputation and rehabilitation. We foster a cooperative approach to care, and want you to feel at home in our office. Our multi-disciplinary team approach to care includes working closely with your physician, and therapists – but is all starts with the most important member of our team – YOU, the patient! Regardless of how a limb is lost, whether in an unforeseen accident or by a planned amputation, we understand the trauma involved. You need a prosthetic team that works together for their success and assists them every step of the way. TSOP is happy to provide this level of support to our patients, and we seek to be a resource in each aspect of your prosthetic care.
There are three basic modes of dressings to shape and help protect the sutures on your residual limb:
- Most of the time, soft dressings are prescribed to allow for daily dressing changes and skin evaluations. After the dressings are applied, the initial application of an ACE wrap bandage is applied by your nurse, physical/occupational therapist or prosthetist. Often, the ACE wrap will be measured for a custom fit shrinker sock. The use of the ACE wrap and/or shrinker is critical in the shaping and control of swelling in the residual limb. You will be required to wear the shrinker/ACE wrap after massaging. The shrinker is worn until it is felt that the residual limb is stable from swelling. You may be required to wear a knee immobilizer to prevent knee contractures.
- Rigid dressings consist of a plaster of paris or a fiberglass tape shell with soft sterile lining against the skin. Often a simple tube or alignment device with an artificial foot is attached to the end of the rigid dressing for minimal weight bearing and so that walking can begin immediately. This rigid dressing is generally changed in two weeks for evaluation of the stump for healing, and a new tighter sterile rigid dressing is applied.
- We may fabricate a custom plastic removable rigid dressing that can be worn at all times. It is the best option to shrink, shape and protect your residual limb. It is removable to assess and clean your incision every day while it aids in holding your knee straight.
Two to three weeks after your surgery, you will return to your doctor for your first post operation visit and have your staples removed. Your second post operation visit will be two to three weeks later. At this visit, any remaining sutures will be removed. Generally, at the second post operation visit, the doctor will write a prescription for your prosthesis.
Please Note: The above is a typical post operation guideline. However, each doctor is different and results may vary.
Once your residual limb has reached an acceptable shape, you are seen for the measuring and molding of your residual limb for your custom prosthesis.
During your first visit to our office, you will be asked to fill out a patient information sheet for contact purposes, and sign any applicable insurance forms. Your appointment will take approximately 45 minutes to two hours, depending on the complexity of the prescription, for the evaluation. This initial process is generally performed at our office.
During the second visit, which is usually within 1-2 days, a socket is fabricated and designed to minimize pressure over areas of less tolerance (boney areas, scar tissue, nerve ends, sores, etc.) and monitor and reduce weight bearing on tolerant skin areas. The pressure marks on your residual limb are evaluated closely to determine appropriateness of the fit.
Expect general tightness and minimal discomfort initially. Although the areas of your limb we utilize for weight bearing are well suited for acceptance of your weight, they have never been required to take your full body weight prior to the amputation. It may take some time for your body and residual limb to become tolerant to these new pressures. We will help you by providing a wearing schedule to allow a ‘break in’ period.
The socket is placed on an alignment device to allow the Prosthetist to make any required adjustments in length and alignment to improve comfort and gait. The appropriate suspension is also determined. This visit is sometimes very demanding, and requires one to two hours to successfully reach an acceptable result. Should the initial fitting not be satisfactory, an additional fitting may be required, or alterations to the initial prescription may need to be considered.
When you and your Prosthetist determine that the device is fitting well, you can take your Prepatory prosthesis with you, following the wearing schedule outlined by the Prosthetist.
Your Prepatory prosthesis is sometimes referred to as your ‘temporary’ device. It should be noted that the term “temporary prosthesis” only implies that we expect your residual limb to continue to change in size/shape due to the pressures from the socket, and the increased circulation from greater activity. The Prepatory device is structurally sound and anatomically custom designed for each individual, but is not usually cosmetically finished. It allows for your body to prepare to wear a prosthesis full time, while teaching you how to accept weight through the prosthesis and learning how to walk. We understand that your limb will change dramatically in volume, over the first 2-6 mths. We take this into consideration during the fabrication process and design the socket with maximum adjustability and volume control. This allows for greater modifications to optimize fit for a longer period of time, and can lessen the overall cost initially.
It is recommended that you work with a physical/occupational therapist on prosthetic gait training. We will also work closely with you and your therapist to maximize your ambulatory potential. Generally, in the case of an upper extremity amputation, you are trained by an occupational therapist knowledgeable in prosthetics.
As your limb changes (shrinks) in volume, you will need to add additional prosthetic socks to tighten the fit. Changes in the size of your residual limb are expected and sometimes inconsistent. Close maintenance is critical by you, your therapist and our staff. Should changing the sock ply fit not provide the required comfort and/or function, you should contact our office as soon as possible. We will do everything we can do to make you as comfortable as possible, in the rare instance that the issue can not be corrected prosthetically a referral to your doctor may be warranted.
Frequently Asked Questions
How do I care for my residual limb?
Any wound from amputation or other surgery is at risk of becoming infected because the skin opening can allow germs or dirt to enter the bloodstream. Infections can cause tenderness or pain, fever, redness, swelling and/or discharge. These infections can lead to further complications, surgery or even death if not treated properly.
You will always need to pay special attention to the hygiene of your residual limb (not only just after the surgery); because it will be enclosed in the socket or liner of your prosthesis and so it will be more prone to skin breakdown and infections. You should examine your residual limb every day. You should check for skin changes, such as blisters, redness, soreness, swelling, pain or drainage. Use of a long-handled mirror will help you identify skin problems early. Inspect all areas of your limb, including the back of your residual limb, and skin creases and all bony areas. If you notice any skin changes, please call your Prosthetist right away and do not wear your prosthesis until your Prosthetist has evaluated the situation
Remember: The best way to handle an infection or a problem area is to PREVENT it form causing any serious issues. Follow these guidelines:
Wash your residual limb with mild soap and water, then rinse it off and pat it dry. Do this at least once a day, more if you perspire a lot or are treating a rash or infection. Rinse thoroughly with clean water to remove all soap.
Wash anything that comes into contact with your skin (liners, socks, inner socket, etc.) with mild soap and water, rinse, and dry (check the manufacturer’s washing instructions).
Dry your skin by patting it with a towel. Be sure your residual limb is completely dry before putting on your prosthesis.
Consult your Prosthetist before using moisturizing creams or lotions. Vaseline or petroleum-based lotions degrade some types of prosthetic liners. Only use softening lotions when your skin is at risk of cracking or peeling. If a moisturizing lotion is needed, it is best to apply it at night or at other times when you will not be wearing your prosthesis. Do not apply lotions to any open area. Use only enough softening lotion to avoid flaking, peeling, and dry skin.
Maintain a good prosthetic fit; learn how to adjust your sock properly, if applicable, or go for a prosthetic adjustment if you start to get redness over a pressure area. This will prevent the pressure area from becoming a pressure sore.
Maintain correct alignment of your prosthesis by wearing the correct heel height for your foot and maintaining a good socket fit.
Eat a balanced diet and drink plenty of water to maintain supple, healthy skin.
If you are a diabetic, monitor and maintain your glucose levels.
If you have decreased sensation in your limb, remove your prosthesis several times per day to check for pressure areas.
Do not shave your residual limb; pressure from the prosthetic socket on “stubble” can cause the hair to grow inward, become painful and, in the worst cases, even become infected. Never use chemical hair removals on your residual limb.
How often should I change my prosthetic socks?
Prosthetic socks and liners should be washed daily, carefully following the manufacturer’s recommendations. Wearing a sock stretches it and perspiration hardens it. Washing and proper care restores its shape and softens it. Proper care of socks will reward the amputee with longer service and greater comfort. A sufficient supply of socks should be maintained to allow clean socks to be worn each day and to allow several days after washing before wearing.
Socks should be changed daily or as soon as they become moist with perspiration. However, if your sock is not in direct contact with your skin, worn between your liner and the socket, you may not need to change it so frequently. Throughout the day, the size of your limb may change. It may be necessary to change the thickness of the sock you are wearing. Your prosthetist can explain to you the relationship of sock thickness to proper prosthetic fit.
Prosthetic Socks: The prosthetic socks you have been provided are very important, in order to ensure proper fit and function of your prosthesis. The correct number of socks and correct ply, can enhance fit and function as well as prevent irritation to your residual limb. Prosthetic socks come in many thicknesses. You will learn how to adjust the number and thickness of socks to achieve the best fit.
When you receive your prosthesis, your prosthetist will show you how to apply the proper ply of socks. Your residual limb, as with your body in general, will tend to fluctuate in volume. As a result, you will need to modify the volume of your socket with the number of plys of socks you wear.
Depending on the stability of your limb volume, you may need to address your sock ply fit often during the day, or not at all. If slight swelling occurs, or the socket feels too tight, you will need to decrease the total number of ply of socks worn with the prosthesis. Subtract one ply at a time until a comfortable fit is achieved. Conversely, if the socket feels very loose and your limb has lost size or volume, you will need to add socks in order to take up the undesirable space in the socket. Add one ply of sock at a time until a comfortable fit is achieved. Remember, irritation can occur if the socket is too loose or too tight.
Apply one prosthetic sock at a time, filling the rounded end and pulling up over your residual limb. Smooth each sock, making sure that there are no wrinkles.
Sock ply are added together. For example, if you are currently wearing a 3-ply and a 1-ply (this is 4-ply total) and the socket is loose, you can either add a 1-ply or remove all socks and replace with a 5-ply.
How should I clean my prosthetic socks/liners? You may clean your prosthesis with rubbing alcohol OR use a wet cloth and the same soap you use in the shower or bath. Rinse & dry the prosthesis well with a towel. Do not use any chemicals on your device as they may damage the device. Never use a hair dryer to dry your prosthesis as it is heat sensitive.
You will be provided with 2 liners at delivery. Each roll-on liner must be washed each day, and allowed to dry before you put it back on. Alternate your liners day-to-day. If you utilize this system, you will help to extend the life of each of you liners. Once a week, clean the inner, (gel), surface of each liner with a small amount of rubbing alcohol.
Cotton and nylon socks can be machine washed and dried Wool socks should be washed by hand in a mild detergent, reshaped and air dried. Wool socks should also be worn in rotation, as this gives an interval of several days during which the socks can “rest”. Such a rest period allows the wool fibers to regain their natural resiliency and elasticity for optimal comfort.
What is phantom pain or sensation?
Phantom limb sensation is the feeling that the missing limb is still there. Although usually not painful, you may feel uncomfortable sensations such as burning, tingling and itching. Some amputees seek medical help for the phantom pain. Causes of phantom pain may be due to one or more of the following: changes in nerve circuitry, pain before amputation, blood clotting and/or neuroma.
You also may find that certain circumstances seem to trigger an episode of phantom pain, such as: Use of your artificial limb (prosthesis)
- Weather changes
- Pressure on the remaining part of the limb
- Emotional stress