Leg amputation: rehabilitation, possible consequences

There are situations when it is simply impossible to cope with a problem without surgical intervention. In this article I want to talk about rehabilitation measures after amputation of the patient’s legs.

Key Terms

At the very beginning, you need to understand those terms that will be actively used in the article.

1. So, leg amputation is the surgical removal of a diseased limb. The purpose of this action is to save a person’s life. It is worth mentioning that the doctors make the decision on surgical intervention only in the most extreme case.
2. Amputation level is the place where the leg is cut off.
3. Rehabilitation is a set of measures by which specialists of various profiles (doctors, psychologists, orthopedists, prosthetists) teach a person to adapt to everything around him without a lost limb.

Diabetes

Indications for amputation of the lower limb can be many. One reason is diabetes. The disease itself may not lead to this problem. However, in some cases (neglect of the disease, its transition to a decompensated form), medical indications for amputation are possible (this occurs in about 8-10% of patients). When can leg amputation be prescribed in diabetes?

1. Neuropathy associated with damage to nerves.
2. Micro and macroangiopathy (these are violations of the structure and normal functioning of both large and small vessels).
3. Necrotic changes occurring in the lower extremities.

As it has already become clear, the very first and main indication for amputation is a violation of the functioning of the vessels of the leg. This is due to interruptions in the metabolism and the development of a process such as autoimmunization. Stagnation appears in the vessels, oxygen starvation occurs, which makes the legs vulnerable to various infections. And even the slightest bruise can provoke the development of terrible purulent processes. To avoid death, in such situations, doctors make a radical decision. That is, the patient needs leg amputation (with diabetes, such cases are not isolated). Often, only in this way can a patient save his life.

What's important

As it has already become clear, leg amputation is a serious interference with the patient’s life and health. That is why after the operation a person expects a rather long period of rehabilitation. It is worth saying that the success of rehabilitation treatment depends on several factors:

1. A good stump (the quality of the operation itself matters).
2. Corresponding prosthesis (important is the quality work of the prosthetist).
3. Rehabilitation program.

If at least one of these points is imperfectly performed, the rehabilitation process may be significantly delayed.

Postoperative period

Regardless of whether the toe or most of the limb was amputated, the early postoperative phase of rehabilitation treatment remains the most important. What is important in this case:

1. Prevention of various complications, such as infection of the stump, is necessary.
2. It is very important to monitor blood and lymph circulation in the limb.
3. Prevention of stiffness in joints and muscle hypotrophy is needed . In this case, you will need massage and therapeutic exercises.
4. It is also necessary to regulate pain, avoiding them as much as possible.
5. Well, of course, you will need the psycho-emotional support of the patient. Indeed, for almost all people, the loss of a limb is a huge blow.

Stage of rehabilitation 1. Preparation of the stump

If the patient underwent surgery “leg amputation”, several levels of rehabilitation will be necessary during the first year after surgery. So, as mentioned above, the quality of the stump is of utmost importance. It depends on many factors:

1. The length of the stump.
2. Amputation rate.
3. Postoperative scar (it should be located away from the places of maximum axial load).
4. Forms of the stump (it depends on the technique by which the surgery was performed).
5. Contractures, i.e., traffic limits. This is of great importance, since the quality of a person’s further walking depends on this factor.

What else is important to know about stump care

After the amputation of the leg has been performed, it is very important to properly care for the postoperative suture. In the early days, the attending physician and nurse will observe him. Here it is necessary to clarify that patients with vascular pathology and diabetes mellitus deserve special attention, since it is these diseases that increase the risk of infection of the stump. What's important:

1. Stump hygiene is very important. A daily contrast shower is advisable. You can wash your foot with baby soap, after wiping it dry with a towel.
2. The stump should be inspected daily for changes in skin color. This is very important, and with the slightest change you need to consult a doctor.
3. After surgery, the skin of the stump becomes very sensitive. You can cope with this with the help of massage. You can do it with both hands and a small rubber ball, making circular movements. Periodically, the stump should be rubbed with a towel. You need to do these procedures as often as possible, it is better several times a day.
4. It should be remembered that the postoperative scar must be moistened. This is especially important in the first few weeks after the amputation of the legs.

The period of postoperative adaptation in patients with diabetes mellitus is usually longer.

Swelling

The field of leg amputation during diabetes mellitus or another other disease was performed, the patient often has edema. This is not scary, because this is a normal reaction of the human body to surgery. However, the situation should not be left to chance. Necessary measures:

1. For the first time after surgery, the wound cannot be pressured. Therefore, the bandage on the stump is superimposed not tight.
2. In order to cope with edema, you can use the following tools: compression hosiery, elastic bandage, silicone case.
3. If a high amputation of the leg was performed, the patient is recommended to lie down on his stomach twice a day (for half an hour), turning his head in a convenient direction. This is necessary in order for the muscles on the cult to stretch and thereby train and relax.

Joint contracture

Another problem that can occur after leg amputation is joint contracture. That is, the restriction of passive movement in the joint, which can be caused by deformation of muscles, tendons, skin, etc. Preventive measures:

1. The most important thing is to provide the patient with the correct position of the limb. The stump should be straightened, it should not be left for a long time in a bent position.
2. Important is the timely elimination of puffiness and pain. To prevent spinal deformity, you need to use a chair with a special footrest for the stump for the first time after surgery.
3. The patient will also need both passive and active therapeutic exercises. However, you need to remember that you must avoid those exercises that cause pain.

An important point: as soon as possible after surgery, the patient should appear to the prosthetist. Indeed, the sooner a person gets on the prosthesis, the less he will lose the most important dynamic skills, and the easier and sooner the rehabilitation process will be completed.

Phantom pain

Regardless of whether the leg was amputated above the knee or lower, phantom pain can torment the patient . These are pain sensations that the patient feels in a limb that has been cut off surgically. To avoid this, the following points are important:

1. The patient must be activated as soon as possible, i.e., transferred to a sitting position.
2. Massage and lymphatic drainage of the stump is necessary.
3. The pressure in the cult should be uniform. Therefore, the correct bandaging of the limb is very important.
4. Phantom pain can be avoided if a person begins to exercise as early as possible. Physiotherapy is also important.
5. Well, and, of course, the earliest possible prosthetics are of paramount importance.

If phantom pains appeared in the late period (not immediately after surgery), this means that stump care was carried out incorrectly or insufficiently. However, in such cases, you can deal with the problem. Here mirror therapy can help.

Rehabilitation Stage 2. Prosthetics

After the amputation of the leg has been performed, rehabilitation begins with the preparation of the stump for prosthetics and the prosthetics itself. What does this concept mean? So, prosthetics is a specialized type of care for patients who have lost a part of the necessary organ. That is, with the help of a prosthesis, it is possible to restore the normal or close to normal functionality of the lost organ.

About prosthetics

Modern doctors say that after leg amputation, limb prosthetics as early as possible is important. So, primary prosthetics should be carried out already on the 14-21th day after surgery. Repeated prosthetics is prescribed as soon as and when wear of the primary product occurs.

Prosthetics Steps

The prosthetics process consists of a number of stages:

1. The choice of product design, i.e., prosthesis.
2. Measurement from a stump.
3. Cooking plaster positive and negative.
4. Assembly of the product for fitting.
5. Finishing, taking into account all the moments and wishes.
6. Issue of a prosthesis.
7. Learning to use.

Generally speaking, the success of professional rehabilitation of a patient almost entirely depends on the quality of the prosthesis made. Its weight, dimensions, control method, design, aesthetics and cosmeticity are important. You also need to properly fit the product for a single patient. And, of course, the patient’s mood and his desire to return to normal life as soon as possible become the final stage of rehabilitation. If a person had an amputation of a toe , a prosthesis in this case will not be needed. This rehabilitation point can be avoided.

About dentures

It is worth saying that the prostheses themselves are of two types: primary and secondary.

1. Primary prostheses are also called educational prostheses. They are necessary in order to properly form a stump, as well as teach the patient primary skills for their use. It is worth mentioning that as early as possible primary prosthetics makes it possible to prevent the occurrence of movement restrictions in large joints. It is also important to clarify that this prosthetics is carried out in a hospital, because here you need the participation of many specialists.
2. After the primary prosthesis stage, the patient is given a permanent prosthesis (on average for two years).

Types of prostheses

Dentures are made using a wide variety of technologies. They are modular and non-modular (however, most often modular prostheses are used). They consist of the following parts:

1. The receiving sleeve, which is made depending on the impression of the patient’s stump.
2. Adjusting and connecting devices.
3. Carrier module. Varies depending on the required length of the prosthesis.
4. Foot module.
5. Mounts of the prosthesis.

It is also worth mentioning that a permanent prosthesis, unlike a training prosthesis, is also equipped with a cosmetic lining, over which a special stocking is put on. This is necessary so that the prosthesis is as similar as possible to a real leg.

About disability

It is worth saying that a person has disability due to amputation of the leg. So, most likely, at first it will need to be confirmed once a year. However, after a certain time (no later than four years), you can apply for the so-called perpetual disability. If there is an active development of the prosthesis, a decision of the commission may reduce the disability group.