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Below the Knee Amputation and Above the Knee Amputation HF#4887

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Heart and Vascular Care

 

What You Need to Know about Limb Loss

 

This handout will tell you how to take care of yourself at home after your Below the Knee Amputation (BKA) or Above the Knee Amputation (AKA).  Your nurse will review this sheet with you before you go home. 

 

Care of the Incision

 

There are several layers of stitches holding your incision together on the inside and outside.  You may get the stitches wet in the shower.  Do not swim or take tub baths.  Clean the area gently with mild soap and water.  Do not rub.  Remove any dried drainage.  Gently pat the incision dry.  Leave the incision open to air unless told otherwise by your health care team.

 

At your first clinic visit or even before you leave the hospital, your stitches may be removed.  Small pieces of tape called Steri-Strips® may be placed along the incision to help the edges of the incision heal.  You may shower with the Steri-Strips® in place.  Do not soak them in water for any length of time.  Do not rub the incision; just allow the water to flow gently over the site.  Gently pat the incision dry.  After 2 – 3 days, as your wound heals, the Steri-Strips® will begin to curl up at the ends.  You may trim the curled ends with a scissors.  In time the Steri-Strips® will fall off on their own.  If they do not, you can remove them after one week by gently peeling back the strips.


My Residual Limb Care

 

1. Before performing wound care, wash your hands with soap and water. 

 

2. Wash the residual limb with ________________ (soap and water, normal saline, clorhexadine) ___________ times a day.

 

3. Pat dry with sterile gauze. 

 

4. Put  ____________ (4x4, Telfa, Kerlix) on the incision,

 

5. Apply ______________ ( Ace bandage, shrinker sock, rigid dressing).

 

This may change before you leave the hospital.  It is important for you to have a caregiver or family member learn this with you before you leave the hospital.

 

When to Call Your Doctor

 

At least twice each day you should look at your incision site for signs of infection or breakdown.  Call your doctor if you have these signs of infection or skin breakdown.

 

  • An increase in redness at the site or red streaks on your skin that extend from the site.
  • Increased warmth around the site.
  • Increased pain that becomes constant or tenderness around the site.
  • Bulging or swelling at the site.
  • New drainage or bleeding from your site (drainage may be cloudy, yellow, or foul-smelling).
  • Open spots between the stitches where the skin is pulling apart (dehiscence).
  • A temperature of more than 101.5° F (38.5° C), by mouth; taken twice a day 4 hours apart.
  • If you notice the skin along the site is getting darker or turning black.

 

With these symptoms you should contact a doctor right away (go to the emergency room if your doctor cannot be reached).  This could be a blood clot.

 

  • Sudden increase in pain that is not controlled by your pain medicine.
  • Uncontrollable bleeding from incision or anywhere else.
  • Sudden increase in tenderness or swelling in leg.
  • Sudden increase in redness, warmth, or even a bluish skin discoloration in leg.
  • Please refer to Health Facts For You: Deep Vein Thrombosis and Pulmonary Embolism.

Care of the Residual Leg

 

1. Look at your entire leg, front and back, each day.  Use a mirror to look for skin abrasions, blisters, or red marks.  Do not pop blisters!

2. Wash your leg everyday.  It is very important to keep the leg clean.  This prevents skin problems and bacteria from growing.

  • Do not soak the leg.
  • Use warm water.
  • Use mild soaps without fragrance (Example: Dial® soap).

3. Wear ace wraps or a shrinker sock at all times.  This will reduce swelling, unless you are wearing a prosthesis.

  • Reduce the swelling to speed up the amount of time it takes to heal the incision.
  • Reduce the swelling to keep the residuum the right shape when finding a prosthesis to use.
  • Also, elevate the residuum and do not let it dangle.

4. If you are using ace wraps, rewrap every 2 - 4 hours while awake to compress the residuum.  Make sure there are no creases.

5. Wear a leg protector when out of bed.

6. Do not put too much weight or clothing on one side of the residual leg and not the other.
Keep it equal.

7. Avoid rubbing the leg against other surfaces or clothing.

8. Listen to your therapists' advice about how to position your leg and proper ways to stretch.

 

Activity

 

Your doctor would like you to keep doing your exercises the way you learned in Physical Therapy.  If you are able, you should also walk with your walker as much as you can.  Inspect your walker to be sure it is safe.  Check the rubber stoppers for signs of wear.  All of the walker legs should be same height.  You may notice that you tire quickly as you do more.  This is normal.  It should lessen as you get your strength and energy back.  Take rest periods as needed but be as active as you can be to maintain your strength.  Activity and exercise are important in preparing for you prosthesis and keeping muscle.

  • Do not sit with your legs crossed.
  • Do not place pillows under the residual leg to increase comfort; this can increase the chance that the muscles will shrink.

Pain Control

 

It is normal to have pain at the incision site, but not all people have this.  Your doctor may have prescribed pain medicine for you to use at home.  If you needed pain medicine in the hospital, this is often the same.  If you have pain, your pain should, in time, lessen and may be managed with something you can buy over-the-counter.  Be sure to ask your doctor which is best for you. 

 

You may also have one or both of the problems listed here.

 

  • Phantom sensation is the feeling that you still have the amputated part (leg or toe). Often, only the farthest part is felt, and although not painful, there may be tingling, numbness, or pressure.  It may disappear as you get stronger, or it may last throughout life.  Almost all people who have had an amputation have phantom sensation.
  • Phantom pain is actual pain (most often the burning, cramping, squeezing, or shooting type) in the amputated part.  It may be present all the time or it may come and go.  Phantom pain may be relieved with pain medicine.  If severe phantom pain is a problem for you, talk to your doctor about something else for pain relief.  Many people report they have more relief from the medicine called Neurontin, which your doctor can discuss with you.
  • (Please refer to Health Facts For You: Neuropathic Pain)

 

Diet

 

You may resume your regular diet when you return home.  You should avoid constipation Decreased activity as well as some prescription pain medicines can cause constipation. 

You can try to prevent constipation by trying these methods:

  • Drink several glasses of fluids (8-10) 8-oz. glasses of water or fruit juice per day
  • Eat foods high in fiber (whole grain breads and cereals, fresh fruit and vegetables)
  • (Please refer to Health Facts For You: Constipation).

If these do not work, an over-the-counter stool softener or laxative (something that loosens and softens bowels) may be used.  If the problems do not go away, call your doctor.

 

Maintain a stable body weight; this is very important for overall success.

 

Care of Your Other Leg

 

If you have diabetes or have peripheral vascular disease, it is even more important now to take good care of your other leg and foot and protect it from being damaged in any way. 

 

Ways to care for other leg:

  • Look at legs and feet daily for sores, scratches, cracks, blisters or reddened areas.  Report them to your doctor or nurse.
  • Wash your legs and feet daily with mild soap and water.  Avoid soaking.  Dry well.
  • Put lotion on dry skin daily.
  • Let a doctor or nurse clip your toenails or show you how to clip toenails.
  • Wear shoes that fit well.
  • Wear white cotton or wool socks.
  • Check shoes and socks for stones, sharp things, or holes.
  • Do not use heating pads or hot water bottles on legs or feet.
  • Never go barefoot.
  • Ask for a mirror if you are not able to see your foot.

 

Are You at Risk for Poor Blood Flow to the Legs and Feet?

 

You are more likely to have poor blood flow to the legs if you:

 

  • Smoke
  • Have high blood pressure
  • Have high cholesterol
  • Have diabetes
  • Are over age 50
  • Do not exercise
  • Have heart disease in your family

 

Phone Numbers

 

Peripheral Vascular Surgery (PVS) clinic at (608) 263-0186. 

 

After hours, call paging at (608) 262-0486.  Ask for the PVS resident on call.  Leave your name and phone number with the area code.  The doctor will call you back.

 

If you live out of the area, call 1-800-323-8942.

 

 

 

Referemces

 

Ask the Experts! Questions Regarding: Causes and Treatments of Constipation. www.medicinenet.com.

 

Dehydration: How to Recognize and Prevent Its Effects. www.medicinenet.com

 

Fahey, Victoria A. 3rd ed. Vascular Nursing. Philadelphia: WB Saunders Co., 1999.

 

Va/DoD Clinical practice guideline for rehabilitation of lower leg amputation. (2007). www.guideline.gov

 



The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/05/2012

Copyright © 10/29/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4887

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