Occupational Therapy Transtibial Amputation (BKA) Residual Limb Care

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Before the Stitches & Staples Come Out

  • Educate on positioning in bed and sitting. No pillows under knees.
  • Promote stretching in prone position if tolerable (no low back pain).
  • Provide sitting support for wheelchair – residual limb supports.
  • Educate on precautions (non-weightbearing on residual limb).
  • Educate on the purpose of dressing and bandage is to absorb moisture and protect the healing wound.
  • Cover and teach protection of residual limb during showers from water contact.
  • Remind staff to assist with daily dressing changes.
  • Practice transfers onto commode/toilet and shower chairs/benches.
  • Advocate for the timing of Rx and pain management.
  • Prevent and manage pain and phantom limb pain (diary, breathing, distraction, mirror therapy).
  • Strengthen non-involved muscles (shoulder, upper extremities, etc.)
  • Provide psychosocial support and resources for support groups.
  • Prevent infection control – educate others including staff to wash hands or wear gloves when coming into contact with healing site.
  • Promote healthy diet, smoking/alcohol/recreational drug cessation.

After the Stitches & Staples Come Out

  • Depends on MD – approximately 3 weeks after surgery.
  • Begin desensitization (massage, tapping, rubbing).
  • Encourage daily washing with soap and water, patting dry.
  • Introduce A/E including hand-mirror, long handle sponge, reacher.
  • Teach scar massage.

Family Support

  • Emotional support.
  • Assisting with ADLs and IADLs (including cooking, driving, lifting, transport of wheelchair and equipment).
  • Assisting with wound care in all phases of rehabilitation.
  • Helping with desensitization.

Figure 8 Wrapping

Figure 8 Wrapping Directions

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Phantom Limb Pain Causes

  • Being too tired
  • Putting too much pressure on the stump or parts of the arm or leg that are still there
  • Changes in the weather
  • Stress
  • Infection
  • An artificial limb that does not fit properly
  • Poor blood flow
  • Swelling in the part of the arm or leg that is still there
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Sources:

https://www.amputee-coalition.org/wp-content/uploads/2015/08/Care-of-Your-Wounds-After-Amputation-Surgery.pdf

https://medlineplus.gov/ency/patientinstructions/000050.htm

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