Each year, approximately 30,000–40,000 lower extremity amputations are performed in the United States. 30% of lower extremity amputations are performed above the knee (AKA), and 70% are performed below the knee (BKA). In every instance, intensive and specialized rehabilitation is required to adjust to a prosthesis and adapt in order to return to activities of daily living and the hobbies a patient enjoyed prior to surgery.

What is a lower extremity amputation?

An amputation is the surgical removal of part or all of a body part enclosed by skin. In a lower extremity amputation, this could include removal of the lower leg at the level of the hip, thigh, knee, calf, ankle, foot or toes. Lower extremity amputations are classified as either traumatic or non-traumatic.

What are some of the most common problems following an amputation?

• Tightness in the residual limb from lack of use (contractures)
• Pain in the residual limb/phantom pain (feelings of pain from the missing limb) or sensations
• Problems with healing after amputation surgery due to poor blood flow in the residual limb
• Decreased exercise tolerance from other conditions (i.e. diabetes)
• Difficulty balancing and walking
• Increased risk of falling
• Difficulty with hygiene, bathing and dressing
• Increased risk of pressure sores
• Emotional changes such as frustration, anxiety, grief
• Depression
• Lack of attention (neglect) to the residual limb

Preventing sores and infection is critical. Sores can prevent you from using your prosthesis and can become infected. An untreated infection can become very serious and lead to amputation and/or the development of gangrene (black/dead skin and tissue). Gangrene is life threatening.

Initially after surgery, it is very important to keep the incision clean to prevent infection. Sores, blisters and abrasions can also develop from wearing a prosthesis or dragging your residual limb across surfaces.

To prevent infection:

• Wash your hands prior to cleaning the incision or sore
• Clean the incision or sore with saline solution (salt water)
• Dab the incision and surrounding tissue; do not rub as you can break the incision open
and/or damage the skin
• Re-apply a clean dressing as directed by your doctor

If you notice any signs of infection, call your doctor immediately. Signs of infection are:

• Redness, swelling or pain near the incision or sore
• Hot sensation around the incision or sore
• Increasing pain
• Fever
• Pus
• Red lines above the incision or sore

If the doctor prescribes an antibiotic, be sure to take all the medication even if the signs of infection go away. Keep your incision and any sore clean and inspect your residual limb daily. To prevent the development of sores, you should inspect your residual limb daily, especially after removing your prosthesis. A long-handled mirror can be used to look at the end and back side of your residual limb, or someone may look at these areas for you. Skin creases and bony areas must also be checked. If you notice a reddened area, relieve any pressure from that site. If the redness does not go away within 30 minutes, this is a sign that a pressure sore is developing. If you are wearing a prosthesis, do not put the prosthesis back on. All pressure must be removed from the area until the redness disappears. If you see any signs of infection, if a sore or blister develops or if you have noticed pressure areas, sores and/or blisters that do not go away, call your doctor immediately.

For more information regarding the care and use of a new prosthesis, stay tuned to RehabCare Advantage for the next installation in our Moving Forward series.