Just the thought of undergoing an amputation can cause tremendous worry to both the patient and his family. It can be overwhelming especially when you think about the long-term changes that have to be made to adapt to a basically new way of life. Recovery from an amputation does not happen overnight and can result in feelings of frustration and depression that is why a holistic amputee care treatment program is an integral part of the patient’s road to recovery.
The best way to understand the intricacies involved in amputee care is to become familiar with the different stages of recovery that an amputee goes through. Each stage involves a combination of medical, emotional and psychological, therapy and rehabilitation support systems.
Each stage may have a typical duration of recovery but each patient is different and so progresses at their own pace. Setting unrealistic goals and forcing a patient to reach them before he’s ready does not contribute to the patient’s well-being and recovery and should be avoided at all costs.
The amputee care treatment program is designed for amputees, regardless of their level of amputation, their families and a host of caregivers, therapists and doctors so that together, everyone can achieve the goal of amputee recovery and rehabilitation.
Amputees are the primary beneficiaries of such a program. They have a difficult road ahead of them in terms of acceptance and dealing with their new condition, healing, rehabilitation and social re-integration. They need a support system that can help them adjust and to successfully transition through each recovery stage’s progress. Each stage aims to make the amputee healthy and strong - physically, mentally and emotionally - in order for him to eventually reach the stage where he can continue living a normal life despite his condition.
Preoperative stage or before surgery - This is the stage where discussions on the planned amputation surgery take place. Doctors will perform examinations, finalize surgical plans and discuss the effects of the surgery. They will also educate the patient on the support, therapy and rehabilitation needed throughout the recovery phase. The patient may also be asked to speak with a prosthetist to learn about the different types of prosthesis that may be appropriate for him. This is the stage where the patient can ask questions and familiarize himself with the procedure. However, this step or stage is skipped in cases of emergency amputation where the patient is not medically fit to discuss his options.
Postoperative stage or after surgery - This stage involves the time the patient stays in the hospital after surgery, usually between 5 to 14 days. The focus during this time is the healing of the wound caused by the operation. It involves tending to the wound, making sure that there is no bruising and swelling to reduce the risk of infection. This also involves pain management and encouraging the patient to start being mobile to speed up the recovery process. If the amputee had a leg or legs removed, then he will be taught how to manage a wheelchair too.
Post-acute hospital stage or early rehabilitation - This is the stage when the amputee has healed moderately and is able to leave the hospital. The focus is on learning to live with a missing limb, starting with taking care of the residual limb. Though the amputee has left the hospital, the wound from the scar only closes within the first 3 to 4 weeks and it takes even longer for the internal wound to heal. The key to healing the residual limb is through compression therapy, skin care creams and exercises that prepare the residual limb to bear weight for the future prosthesis. It is important to note that the sound limb also needs to be taken care of because it will be under pressure to bear the stress of the residual limb. This stage can take anywhere from 4 to 8 weeks after surgery.
Immediate recovery stage or fitting and rehabilitation - The road to full rehabilitation begins with this stage. At this point, the amputee is stronger, physically healthier and is ready to be fitted with his own prosthesis. This usually begins 4 to 6 months after surgery although some prosthesis may be fitted earlier. This stage involves getting to know your way around the new prosthesis, learning to manage it, taking care of it and being one with it. The amputee may go through one or more temporary prostheses as the body adjusts to weight and pressure. When fitting a leg prosthesis, there is a thing called “gait training” that effectively teaches you to walk properly without putting any stress on other parts of the body.
Stable Stage - The stable stage is the final stage in recovery. By this time, the amputee should have gained the appropriate muscle strength and coordination to function normally with his prosthetic limb. The definitive prosthesis may have been fitted and used at this time. However, the prosthesis may still need regular adjustments from here on out, after at least a year of prosthetic use. Social re-integration is also a focus so that the amputee may be empowered and live independently.
Most complications of amputee care usually result from the surgery and the healing of the actual wound. The preparation before surgery is vital because it is during this time that any other medical conditions that can affect the surgery and the healing are brought out into the open, thereby minimizing their occurrence.
The emotional stability of the amputee also becomes at risk when faced with such an overwhelming and life-changing condition. It is through the help of family and a team of caregivers that this setback is managed.
Gross KR, Collier BR, Riordan WP Jr, Morris JA Jr. Wilderness trauma and surgical emergencies. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 21.
Moorell D. Management of amputations. In: Roberts JR, Hedges JR, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 47.