After surgery, you'll normally be given oxygen through a mask and fluids through a drip for the first few days, while you recover on the ward.
Depending on your general health, you should be able to eat and drink when you have recovered from the anaesthetic.
Your wound will be covered with a bandage or plaster dressing, and a tube may be placed under the skin next to the wound to drain away any excess fluid from the site of the surgery. This will help prevent excessive bruising and swelling at the wound. It's usually recommended that the bandage remains in place for a few days, to reduce the risk of infection.
A small flexible tube, known as a urinary catheter, may be placed in your bladder during your surgery to drain away urine. This means you won't need to worry about going to the toilet for the first few days after surgery.
It's likely that you will experience considerable pain at the site of the operation, so painkillers will be given as required. Let the hospital staff know if the painkillers are not working, as you may need a larger dose or a stronger painkiller.
Preparing for discharge
As you gradually recover from the effects of surgery, you will meet a number of different health professionals, such as a social worker, occupational therapist and physiotherapist, to help plan for your discharge and long-term recovery.
For example, it's likely that an occupational therapist will arrange a visit to see if any aids are needed to make your home environment more accessible, such as a wheelchair ramp or a stairlift. If these kinds of modifications are required, the issue can be referred to your local social services department.
You may also have meetings with a social worker to see if you need any additional support at home, such as meals on wheels.
Your physiotherapist will also teach you a number of exercises at this stage, to help prevent blood clots and improve blood supply while you are recovering in hospital.
You will notice swelling (oedema) of your stump after surgery, which is normal. This swelling can also continue once you have been discharged.
Using a compression garment will help with swelling and the shape of the stump. It may also reduce phantom pain and give a feeling of support to the limb.
Your physiotherapist will measure you for your garment once your wound has healed, and it can be placed over your stitches.
The garment should be worn every day, but taken off before you go to bed. You should be supplied with at least two garments, and these should be washed regularly.
How long it will take before you are ready to go home will depend on the type of amputation you have and your general state of health.
In many parts of the country, it's common to be transferred to another hospital or ward for a period of rehabilitation (see below) following a major amputation. This is usually done when you no longer require the facilities of the surgical ward.
It can take several months before you are fitted with a prosthetic limb if you are a suitable candidate for a prosthetic, so you may be given a wheelchair to get around if you had a lower limb amputation.
When you do go home, you will probably be asked to attend a follow-up appointment a few weeks later to discuss how well you are coping at home and whether you require additional help, support or equipment.
You may also be given details of your nearest amputee support group, made up of both health professionals and people living with an amputation.
Fitting a prosthesis
Prosthetic limbs are not suitable for everyone who has an amputation.
This is because using a prosthetic limb takes a considerable amount of energy, as you have to compensate for loss of muscle and bone in the amputated limb.
If it's thought that your body would not withstand the strain of using a prosthetic limb – for example, if you have a heart condition – a purely cosmetic limb may be recommended instead (a limb that looks like a real limb, but cannot be used).
If you're a suitable candidate for a prosthetic limb, you will begin a programme of activities while still in hospital to prepare for the prosthetic.
Before a prosthetic is fitted, the skin covering your stump may be made less sensitive (known as desensitisation). This will make the prosthetic more comfortable to wear.
Skin desensitisation consists of the following steps:
- gently tapping the skin with a face cloth
- using compression bandages to help reduce swelling and prevent a build-up of fluid inside and around your stump
- rubbing and pulling the skin around your bone to prevent excessive scarring
Your physiotherapist will also teach you a range of exercises designed to strengthen muscles in the remainder of your limb, while also improving your general energy levels, so you can cope better with the demands of an artificial limb.
Depending on what is available in your local area, it can be several months before you get your first appointment with a prosthetist (specialist in prosthetic limbs).
Lower limb prosthetics
There is a large range of lower limb prosthetics. Most lower limb prosthetics consist of:
- a socket is the area where your prosthetic limb touches the remainder of your real limb – the most common type of socket used in lower limb prosthetics is known as a patellar tendon-bearing socket, which is a plaster mould designed to fit around the knee joint
- a suspension system keeps the prosthetic limb in place – examples of suspension systems include strapping systems and suction cups
- an artificial joint is a type of metal hinge designed to replicate the function and range of movement of real joints, such as the knee or ankle joints
- a pylon is a metal rod designed to replicate the function of the main bones of the leg
- a prosthetic foot is made from metal, plastic, or a combination of both, and is designed to replicate the main functions of a real foot, such as bearing the weight of the limb and aiding balance and stability
Upper limb prosthetics
Again, there is a wide range of upper limb prosthetics, which generally consist of:
- a socket is usually made from a lightweight mineral and is designed to fit around the remaining limb, which in most cases is a section of the arm just below the elbow joint
- a suspension system – either a strapping or suction system, which keeps the limb in place
- a control mechanism is designed to replicate the movements of the arm and hand – one commonly used type of control system is to attach cables to muscles in other parts of your body, such as your shoulder or upper arm, allowing you to learn a range of movements that control the prosthetic limb
- a terminal device serves as the "hand" of the prosthetic limb – terminal devices have tended to either be physically realistic and cosmetically pleasing but with little practical function, or look very artificial (such as a hook or a claw) but with a wide range of potential functions, although more sophisticated terminal devices are now being developed that are both cosmetically pleasing and functional
An important part of the recovery process is physical rehabilitation. This is a highly individualised programme that aims to allow you to carry out as many of your normal activities as possible after surgery.
You will work closely with physiotherapists and occupational therapists to discuss what you would like to achieve from rehabilitation, and come up with some realistic goals.
Your rehabilitation programme will usually start within a few days of surgery, beginning with some simple exercises you can do while lying down or seated. If you have had a leg amputation, you will be encouraged to move around as early as possible using a wheelchair.
You will also be taught "transfer" techniques to help you move around more easily, such as how to get into a wheelchair from your bed.
Once your wound has started to heal, you may begin an exercise programme with a physiotherapist in the hospital gym to help maintain your mobility and muscle strength. This may involve activities such as walking using an early walking aid (a "practice leg") while supporting yourself with metal bars running either side of you (parallel bars).
After having a prosthetic limb fitted, your physiotherapist will also teach you how to use your prosthetic limb – for example, how to walk on a prosthetic leg or grip with a prosthetic hand.
Physical rehabilitation can be a long, difficult and frustrating process, but many people will ultimately be able to return to work and other activities as a result.
It's important to keep the skin on the surface of your stump clean to reduce the risk of the skin becoming irritated or infected.
Wash your stump gently at least once a day (more frequently in hot weather) with a mild unscented soap and warm water, and dry it carefully.
If you regularly take baths, do not leave your stump submerged in water for long periods of time because the water will soften the skin on the stump, making it more vulnerable to injury.
If your skin becomes dry, use a moisturising cream before bedtime or when you are not wearing your prosthesis.
Some people find wearing one or more socks around their stump can also help absorb perspiration and reduce skin irritation. The size of the stump may change as swelling goes down, meaning the number of socks you need to use may vary. Make sure you change the socks every day to maintain a hygienic environment.
If you have a prosthetic limb, clean the socket regularly with soap and warm water.
Check your stump carefully every day for any sign of infection, such as:
- warm, red and tender skin
- discharge of fluid or pus
- increasing swelling
If you think you may be developing a skin infection, contact your care team for advice.
Taking care of your remaining limb
After having a leg or foot amputated, it's very important to avoid injury and damage to your remaining "good" leg, particularly if your amputation was needed because of diabetes, as your remaining leg may also be at risk.
Therefore, make sure you avoid poorly fitting footwear, and that an appropriately trained individual (such as a podiatrist) is involved in the care of your remaining foot.
Read more about diabetes and foot care.