Amputations are performed when there has been trauma to a limb, or due to medical conditions that results in poor circulation and tissue death. If a body part is without circulation for more than a few hours, the tissue dies and infection becomes inevitable. The infected limb becomes very painful, and if the area of dead tissue is large enough, an amputation has to be done to save the person’s life. Some of the most common causes of amputations include:

• Trauma – car accident, gunshot wound or crush injuries
• Burns – electrical, chemical, thermal
• Poor circulation (peripheral vascular disease) – diabetes, smoking
• Tumours

The doctor performs several tests to determine the level of the amputation. The doctor will look for the presence or absence of a pulse, the temperature of the limb and sensitivity to touch and pinprick. Tissue that has an absent blood supply (no circulation) will be cold and insensitive, and no pulses will be found. Crush injuries destroy the soft tissues, the blood vessels and the bones in the affected areas, leading to amputation. During the operation, areas of bleeding from arteries and veins are sealed off. The sharp ends of the cut bone are smoothed and curved so that the stump can accept a prosthetic device. All potentially diseased tissue is removed, either in stages or all at once, depending on the circumstances and on the specific disease process.

In a closed amputation, the cut ends of the bone are covered by muscle tissue. This helps to pad the end of the stump and reduce pain. If there is infection, the doctor may initially decide to do an open amputation, where the wound is left open. Once the infection has settled, the doctor will close the wound. In a closed amputation, the doctor often places drains in the stump so that blood and serous fluid can drain from the stump as it heals. Firm dressings are placed over the stump to prevent swelling and promote healing. The limb may have to be elevated in traction for a period so that it can heal properly.

• Wash hands and wear gloves when changing dressings.
• Don’t expose the wound unnecessarily.
• Don’t get the dressings wet when washing.
• Protect the stump and wound from knocks and bumps e.g. when transferring.
• Ensure that dressings are checked and changed regularly.

• Oedema: Reduced muscle tone and inactivity may result in swelling (oedema). This could lead to wound breakdown, pain and reduced mobility. In addition, oedema will delay the fitting and use of a prosthesis.
• Wounds and infection: Infection can have a negative effect on healing and phantom leg pain, and will delay prosthetic fitting.
• Pain: while pain is inevitable following an amputation there are several types. While some are extremely painful, others can feel strange (phantom limb sensation). Your therapists and doctors will advise and help you to manage the pain.
• Muscle weakness and contractures: Muscle weakness occurs as a result of bed rest and immobility. Contractures are caused by poor positioning of the limb and muscle imbalances. Both problems will delay prosthetic fitting and rehabilitation.
• Autonomic dysfunction: The residual limb can appear hot and swollen due to altered control of the sympathetic nervous system.

The orthotist measures and records the amount of swelling to determine when the stump reaches a consistent size.

Measurements for the prosthesis are taken once the stump is an appropriate cone shape and is a consistent size.

If possible, rehabilitation of the amputee begins prior to the amputation, and involves a multidisciplinary team. Communication between the team members, the person with the amputation, and family members is essential. The team needs information to develop a treatment plan, which will take into consideration the patient’s physical and medical status, level of amputation, premorbid lifestyle and cognitive abilities. They will use this information to help the patient set realistic short and long-term goals.

Your physiotherapists will work on muscle strengthening, range of motion of the affected limbs and coning the stump. They will also teach you how to balance in a standing and in a seated position, and how to walk with either a frame or crutches so that you become independently mobile within your home, and possibly within your community environment. Once a prosthesis has been ordered and the stump is in a favourable condition, therapy focuses on gait retraining. The team will assist with prescribing appropriate mobility aids e.g. crutches or a walking frame, and referral to the prosthetist.

The Occupational Therapists will teach you how to wash, dress, and groom yourself independently. The therapists will also teach you how to do safe and independent transfers e.g. in and out of the bath, the shower chair, the car and the toilet. More challenging domestic tasks will be addressed as you progress e.g. shopping and cooking. At a later stage, the possibility of return to work and driving will be explored. Rehabilitation is a very important part of your recovery. It is however important to know that changes and improvements in your functional abilities will not happen all at once.

The rehabilitation process starts in hospital. It is a very crucial time as you learn how to become independent again and how to deal with the challenges of your loss. The team will help you through this adjustment and teach you the skills you need to start re-building your life.

Rehabilitation is a lifetime process…

it does not end when you leave the rehabilitation facility. Your courage, commitment and sense of purpose will help you to live a good and purposeful life.