EARLY

MANAGEMENT

BY: DR ANUM NAZ

Contents
 Clinical team approach to rehabilitation.
 Amputation surgery.
 Postoperative management.
 Pain management.
 Skin disorders and their management.
 Psychological consequences of amputation.
 Clinical team approach to rehabilitation

 Physician & Surgeons.

 Physiatrists.
 Prosthetist & Orthotist.
 Pedorthist.
 Physical therapist.
 Occupational therapist.
 Nurse.
 Social worker.
 Psychologist.
Amputation Surgery
Amputation may be necessary when efforts to salvage
the extremity fail and may be only alternative to return
the patient to a more satisfactory lifestyle.
Indications:
 Peripheral Vascular Disease.

 Trauma.

 Tumor.

 Infection.

 Congenital Anomalies.
Amputation Surgery (cont.)
Objectives of Amputation Surgery:
 The residual limb must be capable of utilizing

prosthesis.
 The length of residual limb should be adequate for

the prosthetic fitting.

 The stump end shouldn’t contain bony edges.

 The residual limb must have proper nerve supply.

Amputation Surgery (Cont.)
Surgical Techniques:
There are three kinds of surgical techniques involved in
lower limb amputation:
 Flap cut

 Myoplasty

 Myodesis
Amputation Surgery Cont.
 Flap Cut:
 It is a technique in which long posterior flap brings to
the front of the stump .
 Provides cushioning to the distal end.
 Rotation flaps provide the
ability to mobilize large areas
of tissue .
 Best surgical technique for
trans-tibial amputation
Amputation Surgery Cont.
 Myoplasty:
 It is a technique in which a group of flexors are
sutured with the group of extensors.
 It is performed in non-ischemic limb.
 Provides a good functioning of
flexors and extensors.
Amputation Surgery Cont.
 Myodesis:
 Myodesis is a technique in which muscles are
attached to bone.
 the posterior muscle flaps are left 2 inches longer
than the level of bony transaction.
 This technique provides a good attachment for
muscles.
Post Operative Management
Rehabilitation of people recovering from amputation surgery has three phases:
1. Healing, from surgery to first fitting of a temporary prosthesis usually 4 to
8 weeks.
2. Maturation, temporary prosthesis to provision and use of definitive
prosthesis usually 4 to 6 months.
3. Definitive, the reminder of the person’s life.
Introduction to post operative management:
 It is a treatment which is provided to amputee after a surgery .

 It helps in providing better rehabilitation protocol.

 It helps to avoid edema.

 Provide healthy stump and a good posture.

 Also maintains well strength muscles.

Post Operative Management (cont.)
 Elevation of the stump:
 It is performed to avoid edema.
 Should keep the stump higher then the heart level.
 In sitting position keep the stump on chair or on
stool.
 In laying position keep the stump on pillow.
POST OPERATIVE MANAGEMENT
(cont.)
 Elastic Bandaging:
 Performed to avoid edema.
 It should be done by applying a uniform pressure.
 For Prosthetist it helps in cast taking, fitting of
socket, reducing phantom pain.
 It should be apply in figure
of 8 to maintain the blood
circulation.
Post Operative Management (cont.)

Contrast Bath:
 It is washing of the stump with warm and ice-cold

water.
 it should be done 3-4 times / day.

 It helps in:

- Toughness on skin
- Reduce phantom pain.
POST OPERATIVE MANAGEMENT
(cont.)
 Shrinker Sock:
 It is made up of elasticized fabric tubing material.
 Helps in maintaining stump posture.
 More effective then elastic bandaging.
 Should only be worn in daytime.
POST OPERATIVE MANAGEMENT (cont.)

Air Splint:
 An inflatable plastic splint, where amputated limb

encased in stockinet, placed in splint. Then closed

and inflated to 25mmHg.
 Edema reduction & promote healing.
POST OPERATIVE MANAGEMENT
cont.
 Exercises:
 Must be perform on regular basis.
 Helps in maturation of stump .
 Prevents edema.
 It includes flexion, extension, abduction and
adduction of the stump.
POST OPERATIVE MANAGEMENT
cont.
 Active Exercises:

 These exercises are performed by amputee by his

self.
POST OPERATIVE MANAGEMENT
cont.
 Resistive exercise:

 These exercises performed by exerting some forces.

 To gain healthy musculature.
POST OPERATIVE MANAGEMENT
cont.
 Cleaning of stump:
 It is used to perform to prevent infections & bad
smell.
 Stump should be clean with mild antiseptic and
lukewarm water.
 Avoid rubbing the stump it can cause abrasion.
 Wipe it with towel.
Pain Management
 Individual with acquired amputations must adjust to
a major life change, as well as cope with pain.
 Although almost all people experience some pain
immediately after amputation.
 Living with chronic pain can impact all facets of life,
including one’s mod, relationships, activity level, and
general well-being.
Pain Management Cont.

 Phantom limb pain:

 Phantom limb pain(PLP), one of the most frequently
discussed consequences of amputation, is defined as
painful sensations perceived in the missing portion of
the amputated limb.
 Management:
 Bandaging, contrast bath,
desensitization and
pharmacologically.
Pain Management Cont.
Residual limb pain:
 Residual limb pain refers to pain in the portion of the
amputated limb that is physically present.
Management:
 Begin exercises as soon as your surgeon allows it. Standing,
walking and muscle stretching.
 Desensitize.
 Keep a pain journal.
 Practice relaxation. We know that
tension and stress increase pain.
It is estimated that 50 percent of pain
can be reduced by relaxation.
Pain Management Cont.
 Back Pain:
 Researches suggests that back pain may be fairly
common in persons with lower limb amputation, and
may contribute to pain-related impairment and
function.
 Management:
 Exercise, pharmacological
treatment & rest.
 Skin Disorders in amputees

 Scar formation.
 Grafts.
 Blisters.
 Abrasion & Erosion.
 Atrophy.
 Ulceration.
 Dermatitis.
 Itchiness.
Skin Disorders in amputees
 Management:
 Laser treatment, oral & tropical medications, surgery
& radiotherapy.
Psychological Consequences of Amputation

 Amputation results in a personal loss, both real and

symbolic.
 Disability after amputation affects the psychological
health of individual.
Psychological Consequences of Amputation cont.

Common psychological consequences after

amputation.

 The psychological effects of amputation are highly

variable and dependent on the persons age, level of
maturity, personality, coping skills, flexibility,
available social support, and whether the amputation
was planned or sudden.
Psychological Consequences of Amputation cont.

 Common psychological consequences after

amputation cont.

 Grief reaction.
 Adjustment reaction.
 Depression.
 Anxiety.
 Post-traumatic stress disorder.
 Body image.
Psychological Consequences of Amputation cont.

 Management:

 Brief psychotherapy.
 Pain management.
 Relaxation training.
 Family responses
and support.
 Web-based
education.
THANK
ss

YOU