Πληροφορίες για ασθενείς που υποβάλλονται σε ακρωτηριασμό κάτω άκρου

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Introduction

This leaflet is designed to tell you about the rehabilitation after having an amputation of your leg. This leaflet is not designed to replace the information discussed between you and your doctor, but can act as the starting point for discussion or as a useful reminder of the key points.

This leaflet includes the following topics:

  • Reasons for amputation
  • Following your operation
  • Role of the Physiotherapist
  • Role of the Occupational Therapist
  • Role of the Disablement Services Centres
  • Phantom sensations and phantom pain
  • Emotions/Feelings
  • Care of the stump(residual limb)
  • Care of the remaining leg
  • Risk of falls
  • Frequently asked questions
  • Where can I get more information?

 

Reason for amputation
Amputation may be offered when all other forms of treatment have been tried or considered and is performed because part of the leg is:

  • So diseased, that life is threatened or,
  • So painful that it makes life a misery or,
  • So injured that it is no longer works as a functional limb.

The main reasons for amputation are:

  • Circulation problems (Peripheral Vascular Disease). This is the most common cause of amputation. Problems come from narrowing of arteries supplying blood to the legs and feet. Without a good blood supply the leg may develop gangrene and ulcers. If the blood supply cannot be restored it may be necessary to amputate.
  • Diabetes mellitus can cause problems with circulation and lead to severe infection.
  • Accidents or injury may cause a traumatic amputation e.g. road traffic accident.


Following your operation

Initially after your operation you may find you have the following attached to you:

  • An oxygen mask.
  • A drip of fluids and medication.
  • A tube in your bladder to collect urine (catheter).
  • A small drainage tube from your stump.

There are different ways pain relief can be administered; the team will decide which will be the best method for you. The possible methods of pain relief are:

  1. Painkillers that are swallowed(oral)
  2. Patient controlled analgesia (PCA)-a machine that you are able to control yourself by pressing a button to gain pain relief.
  3. Epidural-a thin tube inserted into your back; painkillers are given through the tube to numb the lower half of your body.

Whilst a small amount of pain is unavoidable after any operation, it is important that if you experience pain you must tell the team so that your pain can be controlled.


The role of the physiotherapist

Before your operation
If possible, a physiotherapist will see you before your operation to explain what will happen after the surgery. This may include showing you some exercises for before and after your operation. If you have any questions about your rehabilitation please ask the physiotherapist.

After your operation
The day after your operation the physiotherapist will come to see you, to check your chest and show you some breathing exercises. This is important to minimize the risk of chest infections. To begin with you will be shown exercises to do in bed; once you are able some of these may be done in a standing position. It is important that you continue with these exercises as advised to prevent muscle weakness and stop your joints becoming stiff. The physiotherapists will work with the occupational therapists to teach you to move from the bed to a wheelchair. When you are ready, you will start going to the physiotherapy gym. In the gym you may practice exercises, standing or getting in and out of a car. What you do in physiotherapy will depend on your goals and a physiotherapist will plan these with you. If you are able to stand and your wound is healing well you may use a temporary walking aid called the PPAM-AID. This is an inflatable bag inside a metal frame, which fits over your leg. A PPAM AID allows you to put a little weight through your stump to walk in parallel bars. You may also be measured for a compression sock to reduce the swelling in your leg; this is known as a JUZO sock. A prosthesis is the term used for an artificial leg. The team will try everything possible to help you to walk, but for some people it is not possible or is too difficult. If this is the case the team will work with you to help you become as independent as possible with your wheelchair.

If a prosthesis is suitable for you
You will normally be discharged from hospital before receiving a prosthesis. Your rehabilitation will take place at a local hospital. You will need to gradually get used to wearing your prosthesis for longer times during the day. You will be taught how to put it and take it off. It is very important to check the skin on your stump for any signs of pressure from the prosthesis.


The role of the occupational therapist

Before your operation
If possible, an occupational therapist will see you before your operation. The occupational therapist will explain their role in helping you become as independent as possible. They will ask you some questions about your living accommodation and previous abilities so we know what facilities we need to put in place to accommodate your return home. If you have any questions about your rehabilitation please ask.

After your operation
You will be loaned a wheelchair and cushion. The occupational therapist will arrange for you to be supplied with a wheelchair from the wheelchair service for use at home. They will teach you how to do everyday activities such as getting in and out of bed, on and off the toilet, washing, dressing and working in the kitchen. This is done by practice, advising you on different ways of doing tasks or by supplying you equipment to make them easier. The occupational therapist may arrange to visit your home. This helps identify any problems, such as narrow doorways or steps. Sometimes the occupational therapist may need to take you on a home assessment to see how you manage in your home before you are discharged from hospital.

If a prosthesis is suitable for you
The occupational therapist will help you become more independent in everyday activities while you are wearing your prosthesis. As you become better at walking you may practice doing tasks while standing; such as preparing meals or washing up. If you are planning to return to work the occupational therapist can help you with work related activities.

The role of the Disablement Services Centre
You will be referred to the Disablement Services Centre. The main centre is at Medway Maritime Hospital. There are local weekly clinics at Kent and Canterbury Hospital and William Harvey Hospital.

The team consists of:

  • Specialist Amputee Doctor
  • Prosthetist(Person who designs and fits your artificial leg)
  • Physiotherapist
  • Counselor
  • Nurse

 

When your residual limb is healed an appointment will be arranged for you to see the Disablement Service Team. The team will discuss with you  the possibility of a prosthetic leg and will consider your suitability for this.

Phantom sensations
Phantom sensations are a non-painful sensation where you may fell the amputated limb is still there. At first your brain is not use to the leg not being there. The nerves that went into your feet still send messages to the brain even though they’ve been cut. These phantom sensations feel very real and it is easy to think your leg is still there. It is therefore important to concentrate when transferring or standing as you may try to stand on your amputated leg causing you to fall over. Some people find the phantom feelings are painful; this is known as phantom pain. The pain can be a burning, itching, cramping, sharp or shooting sensation. The phantom sensations usually decrease with time as the brain gets used to the leg not being there. If you experience phantom pain discuss it with the team. There are medications and treatments that can help with the phantom pain.

Emotions/feelings
Almost all individuals experience some emotional reaction when faced with losing a limb. You and your family should however recognize that this reaction is a normal part of the process. Talking about your feelings may help. Feelings vary for each person; some of the common feelings are shock, anger, frustration, anxiety, fear, depression or disbelief.

Care of the stump
The remaining part of your amputated limb is known as your stump or residual limb. Once it has healed it is important to continue with the following care:

  • Wash it every morning and evening with soap and warm water; dry thoroughly afterwards.
  • Check your limb daily or more frequently if it is sore. You can do this using a mirror to see the end and underneath.

 

Care of the remaining limb
It is very important to look after your remaining leg. If you have problems with your circulation and diabetes small cuts may become easily infected and can be difficult to heal.

  • Make sure you wash your foot daily and dry it carefully.
  • Never walk about barefoot in case you step on something
  • Ensure you have well fitting shoes that don’t rub.
  • Check your foot regularly to ensure you have no sore areas.
  • If you have any problems with your remaining foot see your doctor or a podiatrist. If you have diabetes you should regularly see a podiatrist.

 

Risk of falls
Having an amputation will affect your balance and can put you at risk of falls. The team will talk with you about possible ways to reduce your risk of falling and if appropriate may practice how to get on and off the floor.

 

Frequently asked questions

-When can I go home?
This is the question most people ask. Unfortunately it is impossible to set a time limit. It depends on your general health before the operation, how quickly you recover and if your home is suitable for you to go home to. The time people spend in hospital can range from a week to a few months. Some people are transferred to a rehabilitation ward to continue their rehabilitation.

-When can I return to driving?
It is a legal requirement to inform the DVLA and your insurance company of your change in circumstance. The local prosthetic centre can advise on any possible car adaptations needed. You should consult with your doctor before considering driving as some medical conditions and medications can influence your ability to drive.

-Can I hop with crutches?
Most patients are not allowed to hop with crutches. Hopping can damage your remaining leg, increase the swelling in your stump and put you at risk of falling.

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