Amputation

The amputation of an inferior limb constitutes, for the person who suffers it, an adversity of considerable transcendence, both from the physical and psychological point of view. The feeling of evident lack, together with that of the loss of a corporal element, is an immediate fact, while the hope in an eventual functional recovery is based exclusively on the virtues of the future orthosis.

This, however, can only provide the expected result if all the actors involved in the patient's treatment intervene effectively.

This includes the surgeon, the rehabilitation doctor, the physiotherapist and the orthopaedist. This team has to coordinate its action around what constitutes its primary objective, i.e. the functional future of the patient.

The participation of the latter to achieve this goal is of paramount importance, so it requires information as clear as possible about the protocol applied, as well as the expected results.

Surgical procedure consisting of the removal, extirpation or resection of part or all of a limb through one or more bone structures, perpendicular to the longitudinal axis of the limb. When it is performed through a joint interline, it is called disarticulated.

• The further success of rehabilitation is directly related to the level of amputation.
• The most distal functional level compatible with a reasonable healing potential should be sought (biological level).
• Pre-operatively assess the patient's fitting possibilities and the amputation level at functional level.
• The preservation of the residual limb length is a success for both the patient, the surgeon and the Rehabilitator at the most distal level.
• A more proximal amputation is preferable to successive amputations at the healing level.
• Tissue viability: (Color, temperature, ischemic pain / Transcutaneous measurement of O2 tissue pressure and intraoperative assessment)

The rehabilitation of the lower limb amputee is a process that includes physical, psychological, occupational management and not just the simple restitution of the amputated limb. The overall treatment should be considered as a continuous dynamic procedure, starting at the time of injury and continuing until the patient has achieved maximum utility of his or her prosthesis and is capable of performing the essential activities of daily living and employment. In Cuba, due to the high prevalence of diabetes mellitus, obstructive arterial disease and accidents, the care of amputees in rehabilitation centres is increasingly frequent. The objective of this article is to establish a treatment guideline based on the information available on the rehabilitation of amputees with lower limbs as an evidence-based protocol for action.

The authors of this work have not received financial assistance for its completion; we have not signed an agreement whereby we receive benefits or fees from any commercial entity. Neither has any commercial entity paid nor will it pay foundations, educational institutions or other non-profit organizations to which we are affiliated.