Publications & Presentaions
Amputation Stump Revision
Introduction
Symptomatic amputation stumps in
the lower limb are a complex problem and can be very difficult to manage. Stump
revision should only really be attempted when there is an identified anatomical
problem such as a neuroma or overgrowth of bone. Revision may also be indicated
if the remaining bones are too long. The ideal length of bone is best discussed
with a Prosthetist who can identify what sort of prosthetic is best suited to
your needs and if shortening would be a benefit.
The Operation
The Operation is carried out as
an in-patient, requiring at least one week in-patient stay and will often
require a longer stay in hospital, particularly if it is necessary to do the
surgery in two stages. If there is any sign of infection, or if the initially
injury that caused the amputation was a very high energy injury, it is often
worth considering doing this operation in two stages. This allows any latent
infection that is stirred up by the surgery to be identified and drained prior
the stump closure.
Doing work on the bone or burying
nerves can be very painful, and therefore it is usually recommended to have a
regional anaesthetic technique associated with the surgery. This would usually
be either an epidural or a peripheral nerve block. This will frequently require
high dependency nursing post-operatively. After the first 48hrs or so it is
possible to wean off these. More advanced techniques and other analgesia such as
a patient-controlled morphine pump can also be used.
Post – Op
During the first week it is
important that you rest and that the stump remains higher than your bottom. For
the first two weeks after the formal closure of your stump it is important that
you do not stand up on crutches for more than a couple of minutes as this causes
significant build up of fluid within the stump that is very difficult to get rid
of later. I would recommend that you use a stump compression stocking such as a
Juzo after the first days after surgery as this helps keep the stump from
becoming too swollen. This, together with not standing upright, can
significantly speed up post-operative recovery.