From amputation to rehabilitation
You find yourself in a new situation after an amputation. What your future life will look like largely depends on yourself. The rehabilitation process as such usually takes up to half a year.
Factors that can influence the rehabilitation process include residual limb changes, an increase or decrease in body weight, your place of residence, family, relatives, friends, your everyday environment and occupation.
Before the amputation
You may have already known for some time that you are facing an amputation. Even though this knowledge is very hard to bear – you are not on your own in this difficult phase of your life. Your treatment team will support you and be open to your questions and problems.
Before the operation, you will be examined in detail several times at the hospital. Tests include blood analyses, an X-ray of the lungs and checking the heart and circulatory functions.
Consultations with doctors
Before the amputation, the doctors in charge will explain to you what happens during the operation. They will also talk to you in detail about the time afterwards. In these consultations, you have the opportunity to ask about anything you consider important. It is best to take notes before the consultations with everything you want to ask the doctors, so you will not forget anything. Do not hesitate to ask follow-up questions if there is anything you do not understand. By the way, doctors are obligated to explain it to you, even several times. In contrast to a planned amputation, severe injuries caused by an accident often require an operation quickly. In such cases, consultations with doctors understandably take place only after the amputation.
If possible, you should begin even before the operation with the exercises you will need for subsequent rehabilitation. This allows you to strengthen your musculature in advance. In case of a pending leg amputation for example, it is useful to practice as soon as possible how to correctly transfer from the bed to a wheelchair. Practicing such activities in a timely manner can make the time after the operation much easier for you. Ask your doctor and physiotherapist which exercises are right for you.
It is also helpful if you talk to an orthopaedic technician even before the amputation in order to determine which prostheses can later be considered for you or not. This gives you a better idea of what to expect during your rehabilitation.
An amputation is a dramatic life event that costs you inner strength. That is why you should seek psychological support. You can discuss a lot of things with therapists trained in psychology, relieving strain on your family and friends. These discussions can also help you gain a lot of strength for the new phase of your life. The earlier you seek this support, the better, since even overcoming mental conflicts and fears contributes to rapid healing and regained quality of life. An amputation combined with fear may lead to depression. This needs to be avoided.
Talking to other amputees
We advise you to talk to people with a similar amputation or illness as yourself. Talking to someone who already has an amputation gives you courage. You are not alone. It is good to hear how someone else is handling a comparable situation, and about the changes (also positive!) they have experienced in their life. Tips are also often exchanged, for example on handling the prosthesis.
If you are seeking contact with other affected individuals, it is best to contact your doctors, therapists or orthopaedic technician. They usually know where you can turn or how to find a self-help group.
Here we want to inform you what the term amputation means, what the different forms are and why an amputation can be necessary.
What does the term amputation mean, and why amputate?
An amputation is the severing of a bone in healthy tissue or the severing of a body part in a joint (disarticulation).
Such an amputation is required when a diseased body part is not expected to heal and the patient's life is at risk as a result. Causes may include circulatory disturbances, infections, accidents, cancer or a congenital malformation of the limbs.
In the cases mentioned above, the need for an amputation is usually known some time in advance. On the other hand, amputations are sometimes necessary entirely unexpectedly, for example due to severe injuries after an accident.
What does the amputation level mean?
The term amputation level describes the place where a body part is amputated. Next to other factors, the amputation level is used to choose a suitable prosthesis in each case.
After the amputation
Directly after the operation, your recovery and the healing of the residual limb are the main concerns. Both are important so that you can begin with rehabilitation soon and a prosthesis can be fitted.
What awaits you after the amputation?
After the amputation, special wound healing dressings (or bandages) are applied to your residual limb. The main objective is fast healing of the surgical wound and preparing the residual limb for your future prosthesis.
The initial phase after the operation focuses on three treatment goals: You should have little or no pain if possible, your residual limb has to become capable of bearing weight and you have to achieve optimum mobility of your residual limb in all directions.
In order to accomplish all of this, it is important for you to have your doctor or physiotherapist show you some important things immediately after the operation: Correct positioning in bed so that the muscles and the joint closest to the residual limb do not shorten or stiffen, regular breathing exercises and light movement and mobility exercises. These measures help ensure that you can be fitted with a prosthesis quickly and without problems, so that you can remain mobile and active.
Immediately after the operation, you will likely be unable to lie still for longer periods of time, nor capable of turning over on your own in bed. Therefore you should get assistance from nursing staff to reposition yourself several times a day. This repositioning is important, since it ensures that you are as pain-free as possible and also prevents the development of pressures sores. A correct body posture is also crucial for your mobility.
Wound healing of the residual limb
When you wake up from the anaesthetic, your leg will usually have a dressing already consisting of simple bandages or a cast with a small tube coming out of it. This tube was inserted into the wound during the operation in order to drain fluid and blood from the wound. Known as a drain, it is removed in the course of wound healing.
In most cases, the amputation wound closes within the first three to four weeks and a scar is formed. But even if the scar appears to have healed well from the outside and only the colour of the scar tissue changes slightly from this point on, the overall scar healing process takes much longer. Approximately one and a half years will pass before it is fully healed beneath the skin.
Intensive care (compression therapy and creams) is tremendously important during this time in order to ensure that the scar tissue remains soft and supple while simultaneously becoming resilient. This is essential for wearing the prosthesis.
Initial residual limb compression
Initial swelling of residual limb tissue is expected after the operation. This swelling (oedema) is a normal reaction to the operation. It usually subsides after about one week.
Soon after the amputation, pressure is put on large areas of the residual limb with the help of elastic bandages, compression socks or other medical aids. The purpose of compression therapy is to reduce the residual limb oedema and optimise your residual limb for your subsequent fitting with a prosthesis. This is important, because a pronounced residual limb oedema would delay wound healing and it would also take longer for the residual limb to reach its final shape, so that a prosthesis can be fitted. Compression also promotes circulation in the residual limb. This reduces pain and helps improve healing of the scar.
What type of residual limb care is most suitable for you – with elastic bandages, compression socks or a silicone liner – depends on the surgical technique, amputation level, wound conditions and the personal experience of your treatment team. The best method for you is chosen.
In order for your body to be prepared for the subsequent treatment steps as well as possible, exercises to strengthen the torso, arm and leg musculature are highly recommended. Have your physiotherapist show you movement exercises that promote your recovery and also provide the best possible training for joints near the amputation site. The exercises can be performed with light weights and therapy bands, from a lying, sitting or standing position. The residual limb should also be included in the exercises.
These movement exercises prevent stiffening of the muscles and joints. Also familiarise yourself with movement patterns that are initially unfamiliar with the amputated leg. Your physiotherapist should show you the exercises an verify that you are completing them correctly. He or she can advise you regarding the right exercises at the respective time.
Now you can work on your mobility. Sitting up in bed on your own and transferring to a wheelchair will probably be difficult for you at first. But you will soon master this with some practice. Once again your physiotherapist should instruct you in detail. Often there are straps or handles on the bed which you can use for assistance. Soon you will also get up for the first time. But since the familiar balancing weight of the amputated limb will be missing, you should expect balance problems at first. A walker or other walking aid can initially help you keep your balance after a leg amputation.
Immediate and early fitting
In some cases, an initial prosthesis can be fitted soon after the amputation. With such an immediate prosthesis, partial weight can be put on the residual limb early on and initial gait training can begin. The immediate fitting is usually provided just ten or so days after the amputation. However, this type of prosthesis is not suitable for all amputation levels. Your doctor, physiotherapist and orthopaedic technician will decide together whether this is an option for you. Should such an early fitting be possible for you, then you will receive a new prosthesis after a few weeks. This is known as an interim prosthesis, individually fitted for you by your orthopaedic technician. It is suitable for initial walking and standing exercises.
Initial swelling of residual limb tissue is expected after the operation. This swelling is a normal reaction to the operation. It can be prevented by applying pressure over the entire surface.
When the residual limb wound heals well, the rehabilitation phase as such begins a few weeks after the operation. In most cases, this will take up to six months.