Stump Care

As part of pre-prosthetic rehabilitation, oedema control and residual limb shaping are essential in preparing the patient for using a prosthesis (Spires, Kelly & Davis, 2013). Therefore the medical team will choose post-op dressings to provide compression and residuum shaping, and to promote healing (Spires, Kelly & Davis, 2013). These dressings are worn for 24 hours a day except for wound care (Spires, Kelly & Davis, 2013).

Types of dressings (Spires, Kelly & Davis, 2013; Manella, 1981):

As part of further oedema control, the residual limb should not be left hanging in a dependent position and should instead be elevated using a wheelchair stump support (Spires, Kelly & Davis, 2013). This will assist in ensuring that the residual limb is decreasing in volume in preparation for prosthetic use (Murphy, 2013).

Furthermore, the amputee should learn to check their stump regularly using their hands and a mirror, particularly after weight bearing and walking (Spires, Kelly & Davis, 2013). The skin should be checked for redness, skin breakdown, blisters, rash and wounds, especially in areas that tend to receive more pressure from the prosthesis (Spires, Kelly & Davis, 2013). If redness, pain or tenderness persist, particularly in areas less tolerant to pressure and at greater risk of skin breakdown, there should be liaison with the prosthetist (Spires, Kelly & Davis, 2013). Furthermore, medical attention should be sought if there are any signs of infection with a blister, wound or rash, or any significant colour or temperature changes suggesting circulatory compromise or infection (Spires, Kelly & Davis, 2013).

Lastly, the amputee should be encouraged to massage their stump daily in order to help scar mobility, reduce adhesions and oedema, and to desensitise the stump (Spires, Kelly & Davis, 2013).

References:

Manella, K. J. (1981). Comparing the effectiveness of elastic bandages and shrinker socks for lower extremity amputees. Physical therapy, 61(3), 334-337. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.858.9275&rep=rep1&type=pdf

Murphy, D. (2013). Fundamentals of Amputation Care and Prosthetics. New York: Demos Medical Publishing.

Spires, M. C., Kelly, B., & Davis, A. (2013). Prosthetic restoration and rehabilitation of the upper and lower extremity. New York: Demos Medical Publishing

Taylor, L., Cavenett, S., Stepien, J., Crotty, M. (2008). Removable rigid dressings: A retrospective case-note audit to determine the validity of post-amputation application. Prosthetics & Orthotics International, 32(2), 223-230. doi: 10.1080/03093640802016795

Vitality medical (2015). Juzo Dynamic Xtra Below the Knee Stump Shrinker 30-40 mmHg

Retrieved from:

https://www.vitalitymedical.com/juzo-dynamic-xtra-below-the-knee-stump-shrinker-30-40-mmhg.html

Gauze and soft dressings

These are used post-operatively to protect the wound and reduce oedema, to allow for wound healing. They do not provide compression or residual limb shaping.

Elastic wraps

A type of soft dressing with compression that can facilitate venous return. Elastic wraps are applied by trained professionals.

Elastic stockinette, such as Tubigrip

These can be applied over local dressings and provide compression, although less compression than a shrinker sock.

Shrinker socks

These are commercially available in many different sizes. They provide even pressure distribution for oedema control and residual limb shaping. They are easy to learn to use and are often used in the longer term.

Rigid removable dressing (RRD)

This type of dressing is made of plaster, fibreglass or plastic, and is designed to be removed for dressing changes and wound inspection. This dressing protects the residuum from trauma, as it has a hard outer casing. Socks can be added as the limb changes volume.

Junzo Dynamic Xtra Below the Knee Stump Shrinker (Vitality Medical, 2015)

Removable rigid dressing (A) RRD alone; (B) RRD placed on a patient (Taylor, Cavenett, Stepien & Crotty, 2008, p. 226)