PHYSIOTHERAPY AND REHABILITATION

Following both primary amputation and delayed closure the stump should be elevated on a traction frame, pillows (lower limb) or a bedside sling (upper limb) for 48 hours. It is not necessary to confine the patient to bed if he can sit in a wheelchair with the stump above hip level.

Gentle active physiotherapy can be commenced three days after injury. This physiotherapy should not disturb the operative dressing nor strain or compress the open stump. Particular attention should be paid to knee extension with isometric contraction of the quadriceps in patients with below knee ampuation and hip extension for those with above knee amputations. Exercising the amputated limb can become rapidly more vigorous after a week.

Stump bandaging to help the swelling subside and shaping of the stump is only useful after skin closure has been achieved. Traditional stump bandaging may only harm the stump if commenced too early.

The patient can usually be fitted with a prosthesis after six or eight weeks from skin closure. In this time attention must be paid to exercising the limb and education of the patient; he should be introduced to other amputees and reintroduced to his family (figure 8).