Patient education: Amputation, below-the-knee – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is amputation? — This is surgery to remove a damaged body part. During a "below-the-knee" amputation, or "BKA," some of the lower leg is removed, but the knee joint is kept in place.

The part of the leg that remains after amputation is sometimes called a "stump." After surgery, you might be able to use a prosthetic device. (A prosthetic is an artificial body part.)

How long it takes for you to recover, and what you need to do, depends on how your stump heals.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Prop your leg on pillows, keeping it above the level of your heart. This might help lessen pain and swelling.

●Take all of your medicines as instructed:

•Use a stool softener to help prevent constipation, if needed. This is a common problem if you take opioid pain medicines. Follow all instructions for taking your pain medicines.

•Take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). These can be used instead of opioids.

●Take care of your incision – You might have stitches, skin staples, surgical glue, or a special skin tape on your incision.

•Keep your incision dry and covered with a nonstick bandage. Use an elastic bandage or a shrinker sock over the top of the bandage. Your doctor or nurse will tell you exactly how long to keep your incision dry.

•Once you no longer need to keep your incision dry, gently wash it with soap and water whenever you take a shower. Do not put your incision underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incision, pat it dry.

•Always wash your hands before and after you touch your incision.

●Use a mirror to help check your stump often. Look for signs of infection such as drainage, redness, swelling, or pain.

●Increase your activity slowly:

•Follow instructions about getting around. You cannot put any weight on the stump until it is healed. You can use crutches, a walker, or a wheelchair to move around.

•Follow instructions for limiting activity and movement until you have healed. The doctor or nurse will tell you what activities are safe to do.

●Change positions often when sitting or lying in bed. This helps avoid knee stiffness.

●Follow the doctor's instructions for wearing a knee immobilizer, if you were given one. This helps you keep your knee straight as your stump heals. If the knee is in a bent position for a long time, the muscles in the back of the leg can shorten. This can cause problems and make it harder to walk later.

●Stop smoking, if you smoke. Smoking lowers blood flow and can slow healing.

●Work with a physical therapist (exercise expert), if you were told to. They will suggest exercises and stretches to help you move and get around safely. The exercises might also make it easier to wear and use a prosthetic.

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments.

If you have stitches or staples, you will need to have them taken out. Your doctor will usually want to do this in 1 to 2 weeks. Some stitches absorb on their own and do not need to be removed. If the doctor used skin glue or skin tape, it will fall off on its own. Do not pick at it or try to remove it yourself.

If you are getting a prosthetic, you will work with a specialist called a "prosthetist." They will begin fittings for your prosthetic leg when your wound is almost healed and there is less pain in your stump.

Some people struggle with sadness or depression after amputation. Your doctor might suggest talking with a counselor to help you cope.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

●You feel short of breath or have trouble breathing.

●You have sharp or severe chest pain when you breathe.

●You are coughing up blood.

●You have signs of stroke, like sudden:

•Numbness or weakness of the face, arm, or leg, especially on 1 side of the body

•Confusion, or trouble speaking or understanding

•Trouble seeing in 1 or both eyes

•Trouble walking, dizziness, or loss of balance or coordination

•Severe headache with no known cause

Call for advice if:

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You have redness or swelling around your incisions.

●You have a large amount of blood coming from your stump.

●You have more swelling in your stump.

●You have numbness or tingling in the rest of your leg.

●The rest of your leg is pale or darker in color.

●You cannot control your pain with pain medicines.

●You feel depressed or are struggling to cope.

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