WHAT TO EXPECT

 

After Surgery:

While it is a complicated process, amputation has affected millions and has not stopped many people from living active and healthy lives. While the recovery and the prosthetic process is unique to each individual, there are some residual limb care routines and prosthetic device maintenance tips that apply to most amputees.

Recovering:

During your hospital stay, it is important to do the following:
- Take care of your wound as it heals
- Stretch and strengthen your muscles
- Learn to transfer safely between your bed and other surfaces
- Learn to use walking aids as needed
- Learn to manage daily living skills

Preparing for the use of your prosthetic limb requires both desensitization of the skin on the residual limb, and strengthening of the muscles surrounding it.

Getting Home:

After you arrive home, you may begin to prepare for your prosthesis fitting:
- Take care of your wound (with sutures or staples still in)
- Keep your residual limb straight as often as you can
- Continue exercises learned in the hospital
- Move safely at all times to prevent falls
- Keep all follow-up appointments

Massage:

Early massage of the residual limb will help develop tolerance to both touch and pressure. Massage can be performed through your compression bandage or sock. A soft, gentle kneading motion works best, applying gentle pressure over the entire limb, including the sutured area. Once sutures are removed, pressure can be increased to access the deeper soft tissues and muscles. An effective massage lasts at least five minutes and can be done three to four times a day or even more if it helps to reduce phantom limb pain.

Tapping:

Gentle tapping of the residual limb with fingertips is an effective way to desensitize the limb and ready it for wearing of the prosthesis and is generally allowed even before sutures are removed. Tapping is most effective when done for one to two minutes, three or four times a day. The intensity of the tapping can increase as healing of the sutured area progresses.

Continue to Desensitize:

Both massaging the residual limb and tapping can be done while wearing a compression bandage or sock. Further desensitization can be accomplished using a progressive rubbing technique on the limb without the compression wear. Start with a soft material like a cotton ball and gently rub the skin of the residual limb using a circular motion. This can be done for two to three minutes twice a day.

When tolerance of the cotton ball has been achieved, progress to something a little rougher, like a paper towel. Finally, move on to using a terry cloth towel. This technique should be done until gentle friction from the towel can be tolerated.

It is important to inspect the residual limb for redness or any unusual skin problems. Using a long-handled mirror, inspect the residual limb whenever the compression dressing is changed. Later, a daily inspection of the limb should be sufficient. Be sure to report anything unusual to your prosthetist.

Mobilization of the forming scar tissue is another vital routine to guarantee greater comfort when wearing a prosthesis. Before the incision heals, press two fingers on the bony part of the limb, press firmly and use a circular motion on the skin and underlying tissue.

Once the incision is healed, perform the procedure over the scar, using the circular motion to loosen the scar tissue. This can be done daily.

Getting ready for fitting- First stage:

During the first stage following amputation surgery your residual limb will be sore and swollen. This is part of the natural healing process. The goal of your care during this time will be to get rid of swelling and to make sure that the end of your limb is not larger than the proximal. This should take 3-6 weeks.

Shaping is performed by using an elastic bandage, shrinker socks, Compressorgrip shrinker, or cast.

Elastic bandage:

The elastic bandage is wrapped around the residual limb with greatest pressure at the end of the limb and decreasing pressure moving toward the body. Turns should be made on the diagonal, so that the bandage does not prevent blood circulation. The elastic bandage will naturally loosen after several hours, so you should rewrap the limb every 3-4 hours or as needed. If a throbbing sensation or pain occurs, remove the bandage and rewrap slightly looser. If pain continues, consult your prosthetist.

Shrinker sock:

Shrinker socks should fit snugly and smoothly around the residual limb. As your limb shrinks, the sock will have a tendency to fall down. At this time, your prosthetist will give you a smaller sock so that it is always snug against your limb. If a throbbing sensation or pain occurs, remove the sock and replace it with a slightly larger one. If pain continues, consult your prosthetist. A compressorgrip shrinker is applied by sliding the tube of fabric on to your leg, twisting the remaining fabric, and folding the end of the fabric back on to your leg. It is best if the edge of the upper layer is lower than the under layer so that the circulation is not restricted in your leg.

Non-removable cast:

One type of shaping cast is non-removable. This cast is worn for 1-2 weeks following surgery and comes above the knee so that that knee will not bend.

Removable Cast:

Another type of cast is removable and is worn at the end of the residual limb. The removable cast is worn with one or more prosthetic socks to keep the cast snug. As your limb shrinks, you should add additional sock layers. The cast is held on to your leg using a belt above your knee or using a sleeve of elastic fabric that goes over the cast and above your knee.

Getting ready for fitting- Second stage:

During the second stage following surgery, your residual limb will continue to shrink. This happens because you are using your muscles less than you did before amputation. After 6-8 months, your residual limb should have reached a stable shape and may now be ready for the prosthetic fitting.  Your physician and prosthetist will recommend a preparatory or definitive prosthesis.

Our accredited professionals are available to walk you through every step of the process.  We welcome any questions or concerns. Please feel free to contact us at any time.

Fitting for a preparatory prosthesis:

The preparatory prosthesis will be used until your residual limb has reached a stable size. This can take 2-6 months. Then you may receive a definitive (sometimes called permanent) prosthesis. This prosthesis may have a more natural look or have more advanced parts. Or, you will continue to use the preparatory prosthesis and it will serve as your definitive prosthesis. During this stage, you’ll learn how to:

Don (put on) and doff (take off) the prosthesis
- Adjust sock ply (thickness)
- Walk with your prosthesis, using parallel bars
- Use a walking aid (such as a walker or cane)
- Walk without an aid, if possible
- Prevent falls
- Care for and cleaning of the prosthesis
- Gradually increase the length of time the prosthesis is worn each day

Important Hygiene Information

Perspiration:

Because your residual limb will be enclosed in a plastic socket, perspiration is likely. This can be a source of skin problems, odor and bacteria. Sprinkling a small amount of baking soda can help, and changing your prosthetic sock more often could also help keep things drier and more comfortable. With consistent use of your prosthesis, perspiration will most likely subside.

Socket Care:

Clean daily with anti-bacterial soap and water or rubbing alcohol. A practical routine might include cleaning at night before bed, allowing time for your residual limb and socket to dry completely overnight. If you use alcohol, wipe out any traces remaining with a damp cloth.

Premier Prosthetics will schedule routine follow-up visits. If you need immediate assistance we can be reached 24x7 at 210-340-2181.

Rehabilitation Process 

New prosthetic users will undergo a rehabilitation process that includes a team of professionals. Your physician, prosthetist, physical, occupational therapist and others cooperate to help increase your mobility and independence.
 
- Closely follow the wearing schedule set forth by your prosthetist.
- Use an assistive device like a cane to help you gradually increase the weight you place on your prosthesis.
- Even when you are not wearing your prosthesis, stay active and build your stamina.

Your prosthetist will play a key role for as long as you wear your prosthesis. Rely on us for your best source for guidance.

Physical therapy will help you learn to use your new prosthesis correctly in a safe environment. Learning to walk on different surfaces is a regular part of the rehabilitation process.

 

YOUR PROSTHETIC FITTING

Once your wound has healed, your first visit to the prosthetist may take place. He or she will begin fitting you with a preparatory prosthesis. During this stage, the main goals are:
- Daily care of your residual limb
- Daily use of a shrinker sock
- Desensitization and scar massage
- Continued stretching and strengthening of muscles

Preparation for fitting

Prosthetic Socks and Liners

It may be recommended that you wear a prosthetic sock or cushioned liner as a protective layer over your residual limb.

It is not unusual to experience fluctuations in the size of your residual limb, especially early on. It is often necessary to adjust the fit of your prosthesis.

A common way to adjust fit is through the use of prosthetic socks. They are measured by thickness or "ply" and usually are available in one-ply through six-ply options. As the size of your residual limb decreases, different combinations of sock plies can be used to keep the prosthesis fitting snugly.

• Keep a written record of your sock size and thickness from your first fitting.
• Track any changes and report these to your prosthetist

A gel liner is an interface that goes directly against the residual limb. A gel liner can provide cushioning and even pressure distribution, and reduce friction. If you are fitted with a gel liner:

• Check the liner for signs of damage and clean daily.
• Use a mild, non-allergenic soap and warm water. Do not use bleach or soaps with perfumes, lotions, or deodorants. Blot dry with a towel and hang to dry overnight.
• Be sure to return the liner to its normal position as soon as possible after cleaning. Do not store the liner inside out.
• Store the liner away from direct heat.