The patient’s bed should have a firm mattress and be adjustable in height with a rope ladder of monkey pole and a cradle. Postoperatively the patient requires regular and adequate analgesics to combat pain which may arise from the wound site or the phantom of a limb. Uncontrolled pain may limit the rehabilitation program
Aims of treatment
- To prevent post–operative complications.
- To prevent deformities.
- To control stump edema.
- To maintain strength of whole body and increase strength of muscles controlling the stump.
- To maintain general mobility.
- To improve balance and transfers.
- To re–educate walking.
- To restore functional independence.
- To treat phantom pain.
Breathing exercises and brisk foot exercises for the unaffected leg to prevent respiratory and circulatory complications are given on the first post–operative day and continued until the chest is clear and the patients are ambulant.
Prevention of deformity
Postoperatively there is a tendency for knee flexion in BK and hip flexion, adduction or abduction in AK amputations. Deformities arise due to pain, unopposed muscle action and the patient sitting for long periods in a wheelchair. They can be prevented by the following:
Positioning in bed–The stump should be parallel to the unaffected leg without resting on pillows. The patient should lie as flat as possible for short periods during the day and progress to prone lying when the drains are out and the patient’s condition allows. The time should be progressed from 10 minutes to 30 minutes three times daily. If the patient has cardiac or respiratory problems or if the prone position is too uncomfortable he should remain supine for as long as possible.
Exercises Strong isometric work to counteract the deformity:
- For the quadriceps in a BK amputation.
- For the hip extensors and adductors in a high AK amputation.
- For the extensors and abductors in a low AK amputation.
Stump board–In a BK amputation the stump must rest on a stump board when the patient is sitting in a wheelchair. Long periods with the knee flexed must be avoided.
Control of stump edema
A swollen stump is slow to heal and will make fitting a prosthesis difficult. The stump board will help to control edema. In addition the bed end should be elevated 30°.