Foundations of Nursing Practice Amputation Prepared by Johnpaul Shapeela

1. Prepared by Johnpaul Shapeela

2. DEFINITION
 This is a surgical removal of a limb or any other part of
the body.
 It is also mutilating procedure resulting in lose of a
part of the body with inevitable lose of function
mainly carried out to save life, restore or improve
function of diseased extremity

3. INDICATIONS
 Trauma
 Gangrene
 Severe burns of a limb
 Neoplasm
 Severe infections like osteomyelitis

4. Continuation…..
The level of amputation is determined by a careful
study of individual case. The surgeon needs to
consider the following;
 likely function of the remaining portion of the limb.
 Blood supply of the stump.
 Weight bearing possibilities after amputation.
 Easy fitting of the prosthesis

5. SITE FOR AMPUTATION
 THROUGH THE ANKLE; The thick skin in the heel is
used to cover the stump as the weight pad. The patient
is able to walk around without an artificial leg for short
distances only. An artificial foot or shoes can be used.
 THROUGH THE KNEE; The anterior larger skin flap is
used to cover the stump. This is performed if bellow
knee amputation is impossible e.g. inadequate blood
supply

6. CONT..
 BELLOW KNEE; 15 to 20 cm of tibia is left bellow knee
joint. An artificial limb will grasp the thigh and there is
no need of shoulder stirrups.
 ABOVE THE KNEE; Which is10 to 20 cm bellow the
hip. Post operatively the patient wears an artificial
limb with a hinged knee which is lockable.
 DISARTICULATION; It’s performed through the hip
joint. The patient has a flat sloppy side to the pelvis
and there is a high degree of disability.

7. AMPUTATION SPPECIFIC CARE
 Comfort measure
A bed cradle should be utilized to relieve pressure on the stump. The stump
during immediate post op period, stump should be maintained in a natural
position lying parallel to other limb in non flex and non abducted orientation.
• Wound dressing
This is in form of soft dressing and stump dressing.
First dressing to be changed in 72 hrs and this need to be reapplied at regular
intervals. This helps to shape the stump.
Pain medication should given appropriately prior dressing change. A special
bandage with elastic properties may be used to maintain uniform compression
and thereby reducing edema. This will also help in prosthesis fitting.
 1 or 2 vacuum wound drains will usually be in position, should be removed
within 48hrs unless the drain is excessive .

8. PHANTOM SENSATION
 It’s the name given to the painful sensation
experienced by some pts following amputation. As for
many pts not only the pre op pain is felt but also the
whole limb seems still to be present.
 This perception may continue for many months after
amputation . Regular effective analgesics in the
immediate post op period are thought to reduce the
incidence of phantom.

9. PREVENTIVE FLEXION
CONTRUCTURE
 Where possible, pt should lie prone at a regular
interval commencing from the first post op day to
prevent the development of a flexion contracture of
the stump.
 The pt normally sleeps lying prone can return to this
position easly.

10. MOBILIZATION
 The pt should sit out of bed within 12 hrs of surgery,
may use wheelchair initially.
 Skills of standing and transferring from bed to chair,
wheelchair to toilet will be developed under
supervision of a physiotherapist. This increases the pt’s
independence and improves the morale.
 Physiotherapist to will supervise walking cause pt will
find it difficulty with altered balance. Also assure the
pt that this will be overcomed.

11.  Clothing or dressing
pt should adapt till prosthesis is supplied
 Promoting independence
teach pt how to take care of stump once sutures are
out, skin hygiene, moist of skin twice a day and
inspecting the whole stump for infection.
 Social adaption
 discharge