Amputation

The limb is gone, but the patient still feels it burning. Phantom pain is real, not psychological — and how you position that residual limb in the first 24 hours determines months of rehab outcomes.

Amputation removes part or all of a limb due to peripheral vascular disease (most common cause — roughly 80% of cases), trauma, infection, or malignancy. Nursing care centers on three priorities: hemorrhage prevention, residual limb shaping, and pain management including phantom limb pain. Post-op, keep a tourniquet at the bedside; if hemorrhage occurs, apply direct pressure first and use the tourniquet if bleeding is uncontrolled. Elevate the residual limb on a pillow for the first 24 hours only to reduce edema, then position flat or prone to prevent hip flexion contracture — this is one of the most tested timing distinctions. For above-knee amputation (AKA), prone positioning is emphasized to prevent hip flexion contracture; for below-knee amputation (BKA), avoid prolonged knee flexion by keeping the limb extended. An elastic bandage or shrinker sock is applied in a figure-eight pattern (distal to proximal) to shape the limb into a cone for prosthetic fitting. Phantom limb pain — real neuropathic pain from severed nerve pathways — occurs in up to 80% of amputees. Treat with mirror therapy, gabapentin, or TENS, not dismissal. Assess the residual limb for signs of infection, wound dehiscence, and skin breakdown with every dressing change.

Key Distinctions

Don't confuse phantom limb pain (painful sensations perceived in the missing limb) with phantom limb sensation (non-painful awareness the limb is still there) — both are real, but treatment urgency differs. Students forget that elevation is only for 24 hours post-op; prolonged elevation promotes hip flexion contracture. A figure-eight wrap goes distal to proximal — wrapping proximal to distal creates a tourniquet effect and impairs healing.

Clinical Pearl

Pillow for 24, then pillow no more — after day one, the residual limb stays flat or prone to prevent contractures that can ruin prosthetic fit.