I. Positioning and Edema Control After Surgery

Within the first 24–48 hours after surgery, a pillow may be placed under the residual limb to help reduce swelling.

For below-knee amputees, the knee should remain fully extended when the limb is elevated. Do not place a pillow directly under the knee, as this may lead to knee flexion contracture.
After 48 hours, the pillow should be removed to prevent joint contracture and deformity.
For above-knee amputees, elevation of the residual limb is generally not recommended. A flat supine position is preferred.

II. Phantom Limb Sensation and Phantom Limb Pain

Phantom limb sensation and phantom limb pain are common after amputation.

To help manage these symptoms:

Observe the residual limb directly after surgery.
Once the wound is stable and with the physician’s approval, gently tap the residual limb using a cupped hand.
Perform this 3–4 times daily for 10–15 minutes each session.

These sensations usually decrease gradually within a few weeks or after prosthetic fitting.

III. Cold Therapy (Ice Application)

Ice packs should only be used as directed by the physician to avoid compromising blood circulation or interfering with wound healing.

IV. Proper Positioning of the Residual Limb

To prevent joint contractures and deformities that may delay prosthetic fitting, proper positioning should be maintained.

1. Standing Position

Keep the pelvis level and balanced.

2. Residual Limb Position

Keep the residual limb in an adducted (toward the midline) and naturally extended position whenever possible.

3. Supine Position

The residual limb should lie flat on the bed.

V. Positions to Avoid

To prevent joint contractures and hip abduction deformities, follow these precautions:

1. Avoid Pillow Placement

When lying supine or in a semi-reclined position:

Do not place pillows under the residual limb, buttocks, or knees, as this may prevent full joint extension.
Do not place a pillow between the legs, which may prevent the legs from remaining together.

2. Avoid Hanging the Knee in Flexion

When sitting on the edge of the bed or in a wheelchair:

Do not allow the knee to remain bent and dangling.

3. Avoid Prolonged Sitting

Do not maintain the same sitting position or remain in a wheelchair for more than one hour at a time.

4. Do Not Cross Your Legs

Never place the residual limb over the intact limb.

5. Avoid Resting the Residual Limb on Crutch Handles

Do not rest or hook the residual limb over the handle of a crutch.

6. Avoid Soft Mattresses

Do not use overly soft mattresses, as they may promote poor positioning and contractures.

VI. Rehabilitation Exercises

Rehabilitation exercises should begin as early as possible. Strengthening the muscles of the residual limb will help improve future prosthetic control.

Exercise Schedule:

At least twice daily.
Perform 15 repetitions of each exercise.
Gradually increase as tolerated.

1. For Above-Knee Amputees

If the wound condition permits:

Lie prone (face down) for 1–2 hours daily.

2. Exercise May Begin on Postoperative Day One

Exercise 1: Straight Leg Raise (For Below-Knee Amputees)

Lie on your back.
Raise the residual limb while keeping it straight.
Lower it back to the bed.
Press downward so that the back of the knee is in contact with the bed.

Exercise 2: Pillow Squeeze Exercise (For Below-Knee Amputees)

Lie on your back.
Place a soft pillow between your legs.
Squeeze the pillow inward using the residual limb.

Exercise 3: Side-Lying Hip Adduction Exercise (For Above-Knee Amputees)

Lie on your side with the unaffected side down.
Move the residual limb inward toward the body’s midline.
Simultaneously move it backward.

Exercise 4: Prone Hip Extension Exercise (For Above-Knee Amputees)

Lie face down.
Lift the residual limb upward.

Exercise Recommendations by Amputation Level

Below-Knee Amputation (BKA):

Exercise 1
Exercise 2

Above-Knee Amputation (AKA):

Exercise 3
Exercise 4

VII. Prosthetic Fitting Timeline and Precautions

(1) Prosthetic Fitting Timeline

Temporary Prosthesis

A temporary prosthesis may be fitted approximately 7–10 days after surgery once the wound is stable.

Permanent Prosthesis

A permanent prosthesis may be fitted approximately 3 months after surgery, subject to approval by the attending physician.

(2) Precautions

1. Inspect the Residual Limb Daily

Check for:

Blisters
Skin breakdown
Pressure sores

2. Do Not Apply Any Products to the Residual Limb

Alcohol may dry and crack the skin.
Oils and lotions may soften the skin excessively and interfere with prosthetic use.

3. Maintain Body Weight and Continue Rehabilitation

Maintain a stable body weight.
Continue strengthening exercises.
Follow proper positioning guidelines.

4. Use Compression Wrapping When Not Wearing the Prosthesis

If the prosthesis is not worn for more than 24 hours:

Wrap the residual limb with an elastic bandage.

VIII. Seek Medical Attention Immediately If You Experience:

1. Signs of Infection

Persistent redness
Swelling
Warmth
Pain
Abnormal wound drainage or discharge

2. Persistent Fever

A fever that does not resolve or continues to worsen.

IX. Elastic Bandage Wrapping of the Residual Limb

Proper use of an elastic bandage can:

Reduce swelling of the residual limb.
Minimize excess soft tissue and fatty tissue accumulation.
Help shape the residual limb for prosthetic fitting.

Wrapping Guidelines

The bandage should be neither too tight nor too loose.
Proper tightness allows approximately two fingers to fit comfortably beneath the bandage.

If the Bandage Is Too Tight

It may cause:

Impaired blood circulation
Pain
Tissue ischemia

If the Bandage Is Too Loose

It may result in:

Inadequate swelling control
Poor shaping of the residual limb

Main Goals of Post-Amputation Care

Promote wound healing.
Prevent joint contractures and deformities.
Maintain muscle strength and mobility.
Control swelling and shape the residual limb.
Facilitate successful prosthetic fitting and use.
Detect infection and other complications early.

Post-Amputation Care and Rehabilitation Instructions