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 is an identified anatomical problem such as a neuroma or overgrowth of bone there. 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 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.
After two weeks you would expect to be at home and able to start doing some work on crutches, although this should be kept to a minimum. It is usually possible to start fitting your prosthesis at 4-6 weeks, depending on comfort levels. The prosthesis can be measured earlier, however, it is advisable not to do a significant amount of weight bearing till the stump is comfortable, which normally takes 4-6weeks