AMPUTATION-COMPONENTS OF A PROSTHETIC PROGRAM

SUMMARY

FOR ALL LEVELS OF AMPUTATION

1. Stump management:

- Skin integrity: surgical wound healing, scars, regular wound dressings
- Investigation and management of wound infection if present: take swabs and cultures of the wound and treat with appropriate antibiotics
- Edema management: dressings, bandaging to use for edema reduction, assessing progress (measuring circumference of stump site)
- Pain: nociceptive pain, phantom limb syndrome, phantom pain, neuropathic pain
- Monitor patient's weight: relevant to fitting of prosthesis
- Compliance with maintenance and mobility exercises

2. Positioning, contracture prevention:
- Prone lie for 30 min
- No pillows under the affected limb whilst in bed (for TTA, TFA)
- No crossing of the limbs whilst in bed (for TTA, TFA)
- Avoid prolonged hip flexion (in the intact hip)
- Keep stump supported on leg-board (for TTA)
- Ensure sufficient ROM in the residual limb; for TTA: < 20^o knee flexion contracture; for TFA: < 10^o hip flexion contracture

3. ROM and strengthening exercises, deep breathing exercises/chest physiotherapy.

4. Early mobilization and transfers to prevent DVT, pressure ulcers & deconditioning.

5. Prosthetic prescription: measurement, fitting, temporary prosthesis, definitive prosthesis.

6. Patient education regarding care of stump & prosthesis, pain management.

7. Prosthetic training.

8. Follow-up.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.