Risks with transfemoral amputation
Every operation involves risks and complications, but we always strive to keep them as low as possible. The most common complications include impaired or delayed wound healing, bleeding, nerve damage that can lead to phantom pain, infection or inadequate subsequent residual limb care. In addition, there are general surgical risks, such as intolerance to anaesthesia, pain and the risk of vascular occlusion as a result of long periods of hospitalisation. Many of the complications ultimately make fitting a prosthesis considerably more difficult, which means that the patient can only slowly regain his or her independence.
Aftercare
The post-operative treatment begins immediately after the operation. First priority after the operation is wound healing. A healthy, properly healing wound is dry, not reddened or swollen and the wound edges are close together.
The residual limb can be elevated slightly to support blood flow back to the heart. It should be wrapped with bandages, taking care to use a grain-shaped wrapping to promote blood and lymph flow. Stitches or staples are usually removed after 14 to 21 days.
Most of the time after surgery, patients lie in bed so that the body can recover from the exertions of the operation. To prevent thrombosis and embolism as a result of lack of exercise, heparin injections or other blood-thinning drugs such as aspirin are prescribed. Of course, appropriate pain therapy is also provided.
Pain medication can be administered as tablets or directly into the veins via a drip. Pain catheters (epidural anaesthesia) are also a good alternative.These are introduced into the space surrounding the spinal cord by anesthesiologists and thus inhibit pain conduction and perception at a central level. The correct care of the amputation residual limb is crucial for its subsequent functionality.
The residual limb must later be able to transfer the weight and movements of the body to the prosthesis. To do this, the skin must slowly become accustomed to more pressure and strain, as must the muscles. In the initial period after the operation, it is important to prevent the formation of edema.
Wound healing should be supported, as well as infections and muscle cramps should be prevented. Lymphatic massages are performed to stimulate the lymph flow and support the immune system. The shaping of the residual limb is also crucial.
Bandages are used which are wrapped in a granular form. Bandages must never be wrapped in a circle. This would inhibit the blood flow and lead to oedema.
Besides bandages, so-called liners, which are usually made of silicone, or residual limb socks are also used. They fulfill the same function as bandages. In addition, massages and creams also relieve and care for the skin.
Physiotherapy helps to strengthen the muscles and learn new movement patterns. In summary, the care of the amputation residual limb is very important and must not stop even after the wound has healed. Particularly in the immediate post-amputation period, residual limb care is time-consuming, but if carried out correctly, it leads to good results. The subsequent fitting of a prosthesis then takes further weeks to months, since transitional and learning prostheses must first be made to ensure that the patient can relearn to stand and, in particular, to walk again.
