special subjects
Leg Amputation Rehabilitation
Residual Limb Conditioning and Prostheses
Residual limb conditioning refers to the process of preparing the residual limb in anticipation of use of a prosthesis and includes skin care, physical therapy, and pain management. These measures help promote the natural process of shrinking that must occur before a prosthesis can be used (see Preparing for a Limb Prosthesis ). After only a few days of conditioning, the volume of the residual limb may have shrunk greatly. An elastic shrinker or elastic bandages worn 24 hours/day can help taper the residual limb and prevent edema (see Early ambulation with a temporary prosthesis helps in the following ways: Enables the patient to be active Accelerates residual limb shrinkage Prevents flexion contracture Reduces Phantom pain None The socket of the pylon (the internal framework or skeleton of a prosthesis) should fit the residual limb snugly—made possible by modern computerized design and manufacturing processes. Various temporary prostheses with adjustable sockets are available. Patients with a temporary prosthesis can start ambulation exercises on the parallel bars and progress to walking with crutches or canes until a permanent prosthesis is made. The permanent prosthesis should be lightweight and meet the needs and safety requirements of the patient. If the prosthesis is made before the residual limb stops shrinking, adjustments may be needed. Therefore, manufacture of a permanent prosthesis is generally delayed a few weeks until shrinkage stops. For most older patients with a below-the-knee amputation, a patellar tendon-bearing prosthesis with a solid-ankle, cushion-heel foot, and suprapatellar cuff suspension is best. Unless patients have special needs, a below-the-knee prosthesis with thigh corset and waist belt is not prescribed because it is heavy and bulky. For people with above-the-knee amputations, several knee-locking options are available according to the patient’s skills and activity level. Some newer technologies include microprocessor-controlled knee and ankle joints that enable patients to adjust movement as needed. Patients must learn to care for their residual limb (see Skin Care of the Residual Limb ). Because a leg prosthesis is intended only for ambulation, patients should remove it before going to sleep. At bedtime, the residual limb should be inspected thoroughly (with a mirror if inspected by the patient), washed with mild soap and warm water, and dried thoroughly. Patients should consult with a clinician or prosthetist before treating any of the following possible problems: Dry skin:Lanolinor petrolatum may be applied to the residual limb. Excessive sweating: An unscented antiperspirant may be applied. Inflamed skin: The irritant must be removed immediately, and powder or a low-potency corticosteroid cream or ointment should be applied. Broken skin: The prosthesis should not be worn until the wound has healed. The residual limb sock should be changed daily, and mild soap may be used to clean the inside of the socket. Standard prostheses are neither waterproof nor water-resistant. Therefore, if even part of the prosthesis becomes wet, it must be dried immediately and thoroughly; heat should not be applied. For patients who swim or prefer to shower with a prosthesis, a prosthesis that can tolerate immersion can be made. 