Stump compression socks or bandaging
The wound is covered in a non–stick dressing and fixed with a loose crepe bandage to avoid constriction and ischaemia to the stump. Sutures are removed 2–3 weeks post–operatively.
Elasticated stump compression socks are a convenient method of reducing any edema and conditioning the stump for all–round pressure which the patient experiences when wearing a prosthesis. The pressure should be even and firm, decreasing towards the groin. Diagonal rather than circular turns prevent a tourniquet effect. The bandage should be reapplied at least three times a day and worn day and night, but removed when wearing a prosthesis. When the patient is wearing a definitive limb all day and the stump fits it comfortably in the morning, the application of pressure to the stump can stop unless the patient is confined to bed for more than a day. Regular inspections of the skin must be undertaken and both the socks and bandage must be washed frequently.
If the stump does not heal or breaks down, ultraviolet radiation may be given. For an infected wound an E4 or double E4 is given to the open area only and for an uninfected wound and E1 can be given to both the open are and the surrounding skin.
Maintain body strength and strengthen muscles controlling stump.
The extensors and adductors of the shoulder and elbow extensors can be strengthened by working against weights or springs attached behind to the bed. For example:
- Lying, static quadriceps.
- Grasp stretch lying; shoulder extension and adduction (against springs or weights).
- Grasp lying (elbows bent), straighten elbow (against springs).
- Lying, slow reversals – flexion, adduction, lateral rotation – extension, abduction and medial rotation.
- Sitting, push down on hands, raise buttocks.
- Strong arm muscles are necessary for crutch walking.
- Trunk muscles can be strengthened by crook lying, bridging.
- Lying, rolling.
- Sitting, stabilizations to trunk.
- Crook lying; knee rolling side to side.