New Patient Packet  

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What to expect Post Amputation

Dealing with limb loss can be a very overwhelming experience. The first days and weeks are some of the most difficult. Most amputees wake up from surgery with a lot of questions. The majority of amputees that are seen in the media are young, active individuals who have lost their limb due to an accident. However, most amputees are older individuals whose amputations are performed as life saving measures as the result of poor circulation, diabetes, or another disease. In most cases, you will be able to return to the activities or a similar version of the activities that you performed prior to the amputation. However, it is important to realize that healing and learning to use a prostheses are not overnight processes and will take time, rehabilitation, and patience.

What health care professionals should I work with and what are their roles?

You will continue to see your surgeon and primary care physician throughout the process to monitor the healing of your limb and overall health. You will work with physical and occupational therapists to strengthen muscles and work on getting back to the activities you enjoyed prior to surgery. The PT is responsible for teaching you how to walk with the prosthesis once you get it. You will work with an OrthoFit prosthetist to get your prosthesis. They will design, fabricate, and fit a prosthesis custom made to you. However our prosthetists cannot start the process until you are fully healed, they are available for moral support, and to answer questions prior to the fitting process. You will need to continue to follow up with OrthoFit throughout your lifetime to adjust, repair, and preplace your prosthetic limb as needed.

How long will it take me to heal after amputation?

Everyone is different. The healing process can take longer if there is compromised circulation in the limb. Normally the healing process can take between 4 to 7 weeks. Although the waiting can be frustrating, take advantage of the time and focus on getting your mind and body ready for the prosthesis through rehabilitation services such as physical and occupational therapy.

Are there things I can work on wile I am waiting for my limb to heal?

Yes! It will be important to participate in rehabilitation services as mentioned above to strengthen muscles. You can also prepare for the prosthesis by using massage, desensitization, and scar massage techniques. Your prosthetist can instruct you on the various techniques.

Are there different types of prosthetic limbs and which one is right for me?

There are many different types of prosthetic limbs that range from very high level running prosthesis to very low prosthesis just for cosmetic purposes. The right prosthesis for you depends on many factors and will be determined by your prosthetist, doctors, and physical therapists. 


Prosthetic Supplies

Shrinker:

This is the beige/ white elastic tubular stocking. Its purpose is to reduce swelling, shape and control the volume of your limb. The shrinker would be work as much as possible (except when bathing) as soon as the staples are removed from your limb. Once you have the prosthesis, the shrinker should be worn overnight and at times when the prosthesis or gel liner is not worn during the day.  The shrinker MUST be pulled up above the knee (below knee amputation) or as high into the groin as possible ( above knee amputation). If the shrinker is not worn overnight, it may be difficult to get the prosthesis in the morning due to swelling that happens overnight. * It is normal for the shrinker to stretch out with use, it does NOT need to be replaced frequently*

-         Wear shrinker as much as possible

-        Pull shrinker above knee/ as high into the groin as possible

  

Gel Liner:

This is the thick piece that is fabric on one side and a clear gel on the inside. Its purpose is to attach the prosthesis to tour body and protect your limb and skin from the pressure/stress put on the limb during walking. It is to be worn with your prosthesis at ALL TIMES. The gel lines is to be rolled onto bare skin by turning it inside out and rolling it up the limb, there should be no wrinkles in the liner. Pay careful attention to the position of the locking pin, it should look like it is coming straight out of the bottom of the limb. If the locking pin is not in the proper position, you will have a hard time getting the prosthesis on and locking if it is not place. The gel liner should NEVER be worn overnight. Wash the inside of the liner with warm water and non scented soap after each usage. Rinse well as the soap residue could cause skin irritation. Pat dry with a paper /regular towel and let dry overnight with the fabric side facing out. If the liner is not washed there is a high risk of bacteria growth.

-        Only wear gel liner during the day with prosthetic

-        Turn all the way inside out when putting it on your limb

-        Wash gel liner after each usag 

Socks:

These are the white colored socks with the holes at the bottom that come in differed thicknesses ( as indicated by the colored band at the top). AS A NEW AMPUTEE YOU WILL HAVE TO WEAR SOCKS WITH THE PROSTHESIS. The purpose of the socks are to tighten up the fit of the prosthesis when needed. The limb will fluctuate in volume and as a new amputee you will lose a lot of swelling/ volume in the limb during the first couple months. In other words, your limb will look COMPLETELY different after the first 3-6 months. It will be a lot smaller, especially at the bottom. This will cause the prosthetic socket( the part your leg goes into_ to be too big for your limb. You will make up the difference by adding one or layering several prosthetic socks on top of the gel liner, until it is time to replace the prosthetic socket. If you do not use prosthetic socks, it is likely that you will develop a sore on your leg.

 

Sizing your socks:

Figuring out the correct amount of socks to apply over the liner can be tricky and will take some experimentation. A few signs that the prosthetic socket is too big/ loose and that you need to add socks are :

1.     Your locking pingoes straight down into the lock very quickly without resistance

2.     If you feel a lot of pressure on the front bone and at the bottom of the socket/ feel like all your weight is at the bottom

3.     While you’re walking, the prosthesis starts to rotate on your leg/ your prosthetic foot turns in or out.

If you start to experience any of these, add socks until you feel tight in the prosthetic again. It is important to remember that there is also the possibility of adding too many socks. A couple signs that you have added too many and need to take some off include stubbing your toe when walking, and feeling uncomfortable tight in the prosthetic socket.

Socks should always be work OVER the gel liner with careful attention to clearing the locking pin through the hole at the bottom of the sock.

 

Sheaths:

Not all patients will wear sheaths. Their purpose is to reduce friction between the skin and gen liner. They are applied directly over the bare skin and should fall 2 inches below the top of the gel liner.

 

Prosthetic Wearing Schedule / Skin Checks

Your prosthesis should be worn most days unless there is a medical problem or a skin issue such as an abrasion or blister. It is important to wear your prosthesis on a daily basis to begin the process of getting your body and mind used to wearing an artificial device. It is important however to’ break in the prosthesis”. Slowly work your way up to wearing the prosthesis for extended amounts of time.  The wearing schedule below will be different for each patient, however is a guideline if you choose to use it. Remember you can break up the total amount of hours each day into 2 or 3 wear periods.

 

Days 1-7:  1 to 3 hours of wear

Day 7-14:  4- 5 hours of wear

Day 14-28:  6-8 hours of wear     

**  You may also choose to wear the prosthetic limb during physical therapy exercises ONLY for the first week **

 

It is extremely important to pay very close attention to the skin BEFORE and AFTER each usage, looking for abrasions or blisters, especially around the scar line, or any other sort of unusual mark that was not present prior to wearing the prosthetic. Also be aware of areas of redness that last more than 20-30 minutes. It is important to realize that you WILL most likely see redness, due to new pressures on your leg, and it is not usually a problem unless it lasts longer than 30 minutes.  If one of these problems presents itself, discontinue usage and call your prosthetist. If you cannot inspect the entire limb, a hand held mirror works well. This is something you will do for the rest of your lifetime, as the body goes through many changes that can and will affect the fit of the prosthesis. Checking your skin is ESSENTIAL and is one of the most important things that you can do for yourself as a new amputee.

 

Phantom Pain

The word ‘phantom’ means something that you can feel but cannot see. After a part of the body, like an arm or a leg is amputated, it is common to sometimes feel that the limb is still there. This is called phantom sensation. If the person has pain as though the arm or leg is still there, it is called phantom pain.

 

Cause of pain:

The cause of phantom pain is not known but it probably happens because the nerves of the body are still telling the brain that the arm or leg is still there. There may be an increase in pain messages sent to the brain while gone. Often the pain becomes less over time, especially as you are able to use a prosthesis.  Phantom pain is very real but not everyone will experience it. The pain may feel like burning, cramping, stabbing, or shooting pain. There are a few things you can do to help ease the pain.

Some things that can make the pain worse include:

  • Being too tired, or stressed
  • Too much pressure on the amputated limb
  • Changes in the weather
  • Poor circulation, or swelling
  • An artificial limb that does not fit properly

To help ease the pain you can :

  • Use massage, tapping and squeezing to desensitize the limb
  • Slowly tighten and release the muscle in the limb
  • Take your doctors medication as instructed by your doctor
  • Take a warm bath or shower massage, after the incision line is closed and healed
  • If you have a prosthesis on, take is off for a few minutes
  • If you do not have a prosthesis on, put it on and get active
  • If there is swelling, try a shrinker or ace wrap

 

Preparing for Prosthesis after Amputation

To help you prepare you for a prosthesis, there are some things that can help make your limb less sensitive to touch and pressure. These include:

  • Massage
  • Tapping
  • Desensitization
  • Scar Massage

Some people find that these help lesson phantom pain.

Be sure to check with your doctor before starting these techniques to prevent injury.

 

Massage

You can do massage with your compression dressing on or off.

-        Using one or both hands, gently squeeze and release to massage your limb. At first, be cautious around your suture line or scar.

-        Start at your suture line and massage up around your limb

-        Massage at least five minutes and do this 3-4 times a day.

-        After your sutures are removed and the site has healed, you can increase the pressure when you squeeze to massage the deeper muscles.

Tapping

Tapping should be done for 1-2 minutes, 3-4 times a day. At first, tapping can be done with the compression dressing on or off while the sutures are in place.

  • Use the soft padded parts of your fingers, not your finger nails
  • Gently tap up over the suture line.
  • After the suture has healed, you can increase the pressure. Use your fingers from one or both hands to gently tap the end of your limb to make you less sensitive to touch and pressure

Desensitization

This is done to help make your limb less sensitive so you can tolerate touch against your limb. You will start with soft cotton and move to more rough materials. Your compression dressing must be off to do this technique.

-        You should do this for 2-3 minutes, 2 times a day.

-        Hold a cotton ball in your hand and gently rub the cotton ball on the skin of your limb in small circles and rub your entire limb

-        When you are able, use a rougher material, like a paper towel instead of a cotton ball.

-        As you progress and are able, use a terry cloth towel or washcloth instead of the paper towel.

-        Keep doing this until you are able to tolerate the gentle rubbing of the terry cloth.

 

Scar Massage

This is done to keep your scar from getting stiff and tight.

-        Before your suture line heals, you will not be pressing on the scar line. You will move the skin around the bone at the end of your limb.

-        It is best to do this when your compression dressing is off.

-        Place 2 of your fingertips on the skin over the boney end of your limb

-        Press firmly and move your fingers in circles across the bone. Keep making circles until you have massaged all of the skin around the end of your limb.

-        After your suture line has healed, place your fingers on the scar line and move in circles across your scar. Press in gently along the scar to move the skin over the tissue lying underneath.

 

If you have any questions, please talk to your prosthesis. Our office hours are Monday- Friday 8:00-5:00pm, or leave a recorded message that will be returned.   980-585-3571  

 

Care and Use of New Prosthetic

1.     FOLLOW YOUR PHYSICAL THERAPIST’S INSTRUCTIONS. The first time you wear your prosthesis home, remove it every 1 to 1.5 hours. Look carefully at your residual limb. If there are any red spots, which disappear in 10-20 minutes, do not worry. Your skin is simply reacting to new pressure areas and weight-bearing spots. If, however, the red area does not disappear in ten to twenty minutes, please call our office. We will schedule a prompt appointment. This is especially important if you are diabetic or have vascular disease.

UNDER NO CIRCUMSTANCES SHOULD YOU EVER ADJUST OR CHANGE YOUR PROSTHESIS

The components have been carefully assembled, adjusted and secured according to the manufacturer’s exact specifications and should never be changed by anyone except a qualified practitioner of Orthofit. Please call as soon as you notice a problem.

2.     Do not wear your prosthesis to bed. Put it on when you get up in the morning and take it off before taking a nap or retiring for the night.

3.     You will lose fit in your prosthetic socket as your residual limb changes. This is normal and in most cases adjustments can be made to your prosthesis to accommodate these anatomical changes.

4.     Be prepared to change the amount and/ or the ply of your prosthetic socks as the volume of your residual limb changes. This may occur once in a while, once a week, or even a few times a day. You will need to add or subtract socks as your residual limb swells or contracts.

5.     Was your prosthesis daily where it touches your skin- including liners, sleeves, and socks- with a mild soap using a damp cloth or wipes. Remove all soap residue. If youhave soap allergies, use only soap that has been approved by your physician. Do not immerse your prosthesis in water. Make sure your prosthesis is completely dry before donning. Velcro, straps, and socks should be replaced as needed.

6.     If you have any questions or concerns, please call our office at any time. Office hours are Monday- Friday from 8:00 am to 5:00pm, or you can leave a recorded message and your call will be returned.


Since 2008, OrthoFit has been helping patients improve their quality of life through the use of advancements in custom prosthetics and orthotics. At OrthoFit, we take pride in our strong commitment to our patients and their quality of life. We are continuously improving our product line and developing our clinical and technical skills in order to deliver the best possible outcome for our patients. Through our partnerships in the local medical community and our accreditations, we strive to help the local community and serve an ever growing demand for prosthetic and orthotic services.