After surgery, you will be transferred back to a ward. You will normally be given oxygen through a mask and nutrients and fluids through a drip for the first few days after surgery.
Your amputation 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 is usually recommended that the bandage remains in place for the first five days to reduce the risk of infection.
A small flexible tube, known as an urinary catheter, may be placed in your bladder during your surgery to drain away urine. This means you will not need to worry about going to the toilet for the first few days after surgery.
It is likely that you will experience considerable pain at the site of the operation, so painkillers will be supplied as required. Let your pain nurse know if the painkillers are not working as you may need a larger dose or a stronger type of 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.
Your physiotherapist will also teach you a number of exercises to help prevent blood clots and improve blood supply.
Compression shrinker sock
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 shrinker sock 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 sock once your wound has healed and the sock can be placed over your stitches.
The sock should be worn every day, but taken off before you go to bed. It is important to wash the sock regularly (every 2-3 days) and you should be supplied with at least two socks.
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 is common to be transferred to another hospital or ward for a period of rehabilitation following a leg amputation. This is usually done when you no longer require the facilities of the surgical ward.
Before you leave home, it is 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.
It can take several months before you are fitted with a prosthetic limb, or a prosthetic limb may not be suitable for you (see below for more information on prosthetics), so you may be given a wheelchair if you had a lower limb amputation.
You may also have meetings with a social worker to see if you need any additional support at home, such as meals on wheels. Also, a dietitian can advise on changes you can make to your diet to cope with the extra energy requirements you may have if using a prosthetic limb.
You will probably be asked to attend a follow-up appointment two weeks after leaving hospital 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. Most amputee support groups meet once a month.
Fitting the prosthetic
A prosthetic limb is not suitable for everyone, especially a lower prosthetic limb. Using a prosthetic limb takes a considerable amount of energy because you have to compensate for loss of muscle and bone in the amputated limb.
For example, a person fitted with a prosthetic limb after a transfemoral (above-knee) amputation has to use 80% more energy to walk than a person with two legs. So if it is thought your body would not withstand the strain of using a prosthetic limb – for example, if you had a heart condition – then a purely cosmetic limb may be recommended instead (a limb that looks like a real limb but cannot be used).
If you are 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 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 the level of provision in your local primary care trust, it can take several months before you get your first appointment with a prosthetist (specialist in prosthetic limbs).
Lower limb prosthetic
There is a large range of lower limb prosthetics. Most lower limb prosthetics consist of the components listed below:
- The socket is the interface between your prosthetic limb and 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
- Artificial joints are 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 the 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 the components listed below.
- The socket is usually made from lightweight plastic or graphite (a type of lightweight mineral) 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, 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. You learn a range of movements that allow you to control the prosthetic limb. Alternatively, the control mechanism can be electric and controlled by electrodes implanted in your arm, which respond to the electrical activity generated by certain muscles
- 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. More sophisticated terminal devices are now being developed that are both cosmetically pleasing and functional
It is 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 at least once a day (more frequently in hot weather) with a mild antibacterial 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. This is because the water will soften the skin on the stump, making it more vulnerable to injury.
Using unmedicated talcum powder, such as baby talcum powder, is an effective way to help reduce perspiration (sweat) around your stump.
Some people find wearing one or more socks around their stump can also help absorb perspiration and reduce skin irritation. As the size of the stump may change during recovery as swelling goes down, the number of socks used may vary. However, it is important to 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
- swelling of the skin
If you think you may be developing a skin infection, contact your care team for advice.
Care of your remaining limb
After losing a leg, it is very important to avoid injury and damage to your remaining 'good' leg, particularly if you are diabetic, as the conditions that led to the need for amputation may also be present in the remaining leg.
You should ensure that you avoid poorly fitting footwear, and that an appropriately trained individual (such as a chiropodist) is involved in nail care and other aspects of the care of your remaining foot.