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Pre‐procedural considerations

Equipment

Wheelchair and pressure relief

Patients who have undergone lower limb amputation should be provided with an appropriate wheelchair including anti‐tippers (to prevent the wheelchair from tipping over) and a suitable pressure‐relieving cushion (Smith et al. [119]).

Residual limb support board

Residual limb support boards are required for below‐knee (transtibial) amputees when sitting out in a wheelchair to ensure that the limb is fully supported and help to prevent knee flexion contractures (Figure 7.39). Dependent positioning or dangling of the residual limb is not advisable during the early post‐operative phase due to the risk of increased oedema (Virani et al. [127]).

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Figure 7.39 Wheelchair with amputee stump support. Source: Reproduced from Musculoskeletal Key ([79]).

Procedure guideline 7.16

Positioning a patient with an amputation

Table 7.11 Prevention and resolution (Procedure guideline 7.16)

Problem	Cause	Prevention	Action
Painful residual limb following transfer or change of position	Fear of movement Pressure on distal end of residual limb over wound Residual limb dependent, leading to increased oedema and reduced blood flow Unsupported residual limb	Reassure patient Ensure that the residual limb is well supported following the change of position Ensure adequate analgesia prior to movement and support residual limb wherever possible during the procedure	Explain the procedure to the patient prior to moving their position Ensure that there is no pressure over the wound site following the procedure Offer prescribed analgesia
Wound breakdown	Unsupported residual limb during movement Infection Vascular insufficiency	Ensure that the residual limb is well supported during and following the change of position	Ensure that there is no pressure over the wound site following the procedure Seek medical review