There are situations when it is simply impossible to cope with a problem without surgical intervention. In this article, I would like to talk about rehabilitation measures after amputation of the patient's leg.
Basic terms
At the very beginning, you need to understand the terms that will be actively used in the article.
- So, leg amputation is the surgical removal of a diseased limb. The purpose of this action is to save a person's life. It is worth saying that the decision on surgical intervention is made by doctors only as a last resort.
- The amputation level refers to the place where the leg is cut off.
- Rehabilitation is a set of measures by which specialists of various profiles (doctors, psychologists, orthopedists, prosthetists) teach a person to adapt to everything around him without a lost limb.
Diabetes
There can be many indications for amputation of the lower limb. One of the reasons is diabetes. By itself, the disease may not lead to this problem. However, in some cases (neglect of the disease, its transition to a decompensated form), medical indications are possibleto amputation (this occurs in about 8-10% of patients). In what cases can a leg amputation be prescribed for diabetes?
- Neuropathy associated specifically with nerve damage.
- Micro- and macroangiopathy (these are violations of the structure and normal functioning of both large and small vessels).
- Necrotic changes occurring in the lower extremities.
As it has already become clear, the very first and main indication for amputation is a violation of the functioning of the vessels of the leg. This happens due to metabolic failures and the development of such a process as autoimmunization. Stagnation appears in the vessels, oxygen starvation occurs, which makes the legs vulnerable to various infections. And even the slightest bruise can provoke the development of the most terrible purulent processes. To avoid death, in such situations, doctors make a radical decision. That is, the patient needs amputation of the leg (in diabetes, such cases are not isolated). Often this is the only way to save a patient's life.
What matters
As it has already become clear, leg amputation is a serious interference in the life and he alth of the patient. That is why after the operation a person expects a rather long period of rehabilitation. It is worth saying that the success of rehabilitation treatment depends on several factors:
- Good stump (what matters is the quality of the operation itself).
- Adequate prosthesis (quality work of the prosthetist is important).
- Rehabilitation program.
If at least one of these points is not fulfilled perfectly, the rehabilitation process may be significantly delayed.
Post-operative period
Whether a toe or a large part of a limb has been amputated, early postoperative recovery remains critical. What is important in this case:
- It is necessary to prevent various complications, such as infection of the stump.
- It is very important to monitor the blood and lymph circulation in the limb.
- Necessary prevention of joint stiffness and muscle wasting. In this case, you will need massage and therapeutic exercises.
- It is also necessary to regulate pain, avoiding it as best as possible.
- And, of course, the patient will need psycho-emotional support. After all, for almost all people, the loss of a limb is a huge blow.
Rehabilitation stage 1. Stump preparation
If a patient has had a leg amputation, several levels of rehabilitation will need to be completed during the first year after surgery. So, as already mentioned above, the quality of the stump is of great importance. It depends on many factors:
- Stump lengths.
- Amputation level.
- Postoperative scar (it should be located away from the places of maximum axial load).
- The shape of the stump (it depends on the technique by which the surgical intervention was performed).
- Contractures, i.e.movement restrictions. This is of great importance, since the quality of a person’s further walking depends on this factor.
What else is important to know about stump care
After the amputation of the leg, it is very important to properly care for the postoperative suture. In the early days, the attending physician and nurse will observe him. Here it is necessary to clarify that patients with vascular pathology and diabetes mellitus deserve special attention, since these diseases increase the risk of infection of the stump. What matters:
- Stump hygiene is very important. A daily contrast shower is desirable. You can wash your foot with baby soap, after wiping it dry with a towel.
- The stump should be inspected daily for changes in skin color. This is very important, and with the slightest change, you need to seek the advice of a doctor.
- After the operation, the skin of the stump becomes very sensitive. You can deal with this with the help of massage. You can do it both with your hands and with a small rubber ball, making circular movements. Periodically, the stump should be rubbed with a towel. These procedures should be done as often as possible, preferably several times a day.
- It should be remembered that the postoperative scar needs to be moisturized. This is especially important in the first few weeks after a leg amputation.
The period of postoperative adaptation in patients with diabetes is usually longer.
Edema
Field of how the leg was amputatedwith diabetes mellitus or another other disease, the patient often develops edema. This is not scary, because it is a normal reaction of the human body to surgery. However, the situation should not be left to chance. Required action:
- In the first time after the operation, the wound should not be pressured. Therefore, the bandage on the stump is not tight.
- In order to cope with swelling, you can use the following tools: compression stockings, elastic bandage, silicone cover.
- If a high amputation of the leg was performed, the patient is recommended to lie down on his stomach twice a day (for half an hour), turning his head in a comfortable direction. This is necessary in order for the muscles on the stump to stretch and thereby train and relax.
Joint contracture
Another problem that can occur after a leg amputation is joint contracture. i.e. limitation of passive movement in the joint, which can be caused by deformity of muscles, tendons, skin, etc. Preventive measures:
- The most important thing is to ensure the correct position of the limb for the patient. The stump should be straightened, it should not be left in a bent position for a long time.
- The timely elimination of swelling and pain is important. To prevent deformation of the spine, it is necessary to use a chair with a special footboard for the stump for the first time after the operation.
- The patient will also need both passive and active therapeutic exercises. However, you need to remember to avoid thoseexercises that cause pain.
Important point: as soon as possible after the operation, the patient should see a prosthodontist. After all, the sooner a person gets on a prosthesis, the less he will lose the most important dynamic skills, and the easier and sooner the rehabilitation process will be completed.
Phantom pains
Regardless of whether the leg was amputated above the knee or below, the patient may be tormented by phantom pain. These are pain sensations that the patient feels in a limb that has been cut off surgically. To avoid this, the following points are important:
- The patient must be activated as soon as possible, i.e. transferred to a sitting position.
- Requires massage and lymphatic drainage of the stump.
- The pressure in the stump should be uniform. Therefore, proper bandaging of the limb is very important.
- Phantom pains can be avoided if a person starts exercising as early as possible. Physiotherapy is also important.
- And, of course, the earliest possible prosthetics is of the utmost importance.
If phantom pains appeared in the late period (not immediately after the operation), this means that the care of the stump was carried out incorrectly or insufficiently. However, in such cases, you can deal with the problem. This is where mirror therapy can help.
Rehabilitation stage 2. Prosthetics
After the amputation of the leg was performed, rehabilitation begins with the preparation of the stump for prosthetics and the prosthetics itself. What does this concept mean? Thus, prosthetics is a specialized type of assistance to patients who have lost part of the desired organ. That is, with the help of a prosthesis, you can restore the normal or close to normal functionality of the lost organ.
About prosthetics itself
Modern doctors say that after amputation of a leg, it is important to prosthetic limb as early as possible. So, primary prosthetics should be carried out already on the 14th-21st day after surgery. Repeated prosthetics are prescribed as and when the wear of the primary product occurs.
Stages of prosthetics
Prosthetics process consists of a number of steps:
- Choose the design of the product, i.e. the prosthesis.
- Measurement from the stump.
- Preparation of plaster positive and negative.
- Assembling the product for fitting.
- Final finishing, taking into account all the moments and wishes.
- Issue of the prosthesis.
- Teaching how to use.
Generally speaking, the success of the patient's professional rehabilitation almost entirely depends on the quality of the prosthesis made. Its weight, dimensions, control method, design, aesthetics and cosmetics are important. You also need to properly fit the product for an individual patient. And, of course, the final stage of rehabilitation is the very attitude of the patient and his desire to return to normal life as soon as possible. If a person has had a toe amputation, a prosthesis will not be needed in this case. Itemrehabilitation can be avoided.
About dentures
It is worth saying that the prostheses themselves are of two types: primary and secondary.
- Primary prostheses are also called training prostheses. They are necessary in order to properly form the stump, as well as to teach the patient the primary skills of their use. It is worth saying that the earliest possible primary prosthetics makes it possible to prevent the occurrence of movement restrictions in large joints. It is also important to clarify that this prosthetics is carried out in a hospital, because it requires the participation of many specialists.
- After the primary prosthetic phase, the patient is given a permanent prosthesis (on average for two years).
Types of prostheses
Prostheses are made using a variety of technologies. They are modular and non-modular (however, modular prostheses are most often used). They consist of the following parts:
- Receiving sleeve, which is made depending on the impression of the patient's stump.
- Adjusting and connecting devices.
- Carrier module. Varies depending on the required length of the prosthesis.
- Foot module.
- Prosthesis attachments.
It is also worth mentioning that a permanent prosthesis, unlike a training prosthesis, is also supplied with a cosmetic lining, over which a special stocking is put on. This is necessary so that the prosthesis is as similar as possible to a real leg.
Disability
It is worth saying that a person is en titled to a disability when a leg is amputated. So, most likely, at first it will need to be confirmed once a year. However, after a certain time (no later than four years), you can apply for the so-called indefinite disability. If there is an active development of the prosthesis, by decision of the commission, a reduction in the disability group is possible.
