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Below the Knee Amputation in Children
WHAT YOU NEED TO KNOW:
Below the knee amputation is surgery to remove your child's leg below the knee cap. The part of your child's leg that is not removed is called a residual limb. You and your child will be shown how to care for the residual limb. Your child can also work with specialists to have prosthetics made for him or her. A prosthetic will help your child return to his or her normal daily activities.
Seek care immediately if:
- Your child has severe pain in his or her residual limb.
- Your child's arm or leg feels warm, tender, and painful. It may look swollen and red.
- Your child suddenly feels lightheaded and has shortness of breath.
- Your child has chest pain. He or she may have more pain when he or she takes a deep breath or coughs. Your child may cough up blood.
- Your child's stitches come apart.
- Blood soaks through your child's bandage.
Contact your child's healthcare provider or orthopedist if:
- Your child has a fever.
- The skin around your child's stitches is red, swollen, or pus is coming from the wound.
- Your child has a sudden increase in tenderness in the residual limb.
- Your child has chills, a cough, or feels weak and achy.
- Your child's skin is itchy, swollen, or has a rash.
- Your child feels anxious, depressed, or has trouble coping with his or her condition.
- You have questions or concerns about your child's surgery or care.
- Prescription pain medicine may be given. Ask your child's healthcare provider how to give this medicine safely. Some prescription pain medicines contain acetaminophen. Do not give your child other medicines that contain acetaminophen without talking to his or her healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your child's healthcare provider how to prevent or treat constipation.
- Muscle relaxers help decrease pain and muscle spasms.
- Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
- Give your child's medicine as directed. Contact your child's healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency.
Follow up with your child's healthcare provider or orthopedist as directed:
Your child may have a home health care nurse help him or her between visits. Your child may need to return to have his or her stitches removed. Write down your questions so you remember to ask them during your child's visits.
Physical and occupational therapy:
A physical therapist will help your child with exercises to improve his or her strength. Your child may be fitted with a prosthesis. It may need to be adjusted several times before it fits well. Physical therapists will also help your child learn to walk with the prosthesis and with crutches. Occupational therapists will help your child adjust to daily activities at home and work.
Care for your child's residual limb:
- Clean and care for your child's skin. When your child is allowed to bathe, gently wash around the incision with soap and water. It is okay to let soap and water run over the incision. Have your child take showers instead of baths. Do not let your child soak in a tub or hot tub or swim. These could cause an infection. Your child's healthcare provider will tell you when it is okay for your child to do these activities again. Carefully rinse and dry your child's skin. Look closely at the skin on the residual limb every day. Look for redness, blisters, or scrapes. Do not put lotion, oil, cream, or rubbing alcohol on the residual limb. Rubbing alcohol dries and cracks the skin.
- Prevent infection. Have anyone who cares for your child wash his or her hands before touching the wound. This will help prevent an infection. Only use antiseptic (germ-killing) medicines if healthcare providers tell you to.
- Help your child's residual limb heal. Help your child push the residual limb against a soft pillow. Slowly increase the pressure and start to push the residual limb against harder surfaces, such as the back of a chair. Massage the residual limb to soften the scar, decrease tenderness, and improve blood flow.
Wrap your child's residual limb:
Wrap your child's limb to help form it into a firm cone shape so it will fit a prosthesis. Keep the bandage on at all times except when your child bathes. Rewrap the residual limb 2 to 3 times each day to keep the bandage smooth and tight. At first you will not pull the elastic bandage very tight. Healthcare providers will have you pull the bandage tighter as the wound heals and the stitches are removed. If your child's residual limb hurts or throbs, the bandage may be too tight. Unwrap your child's limb and start over. The following are directions for the figure of 8 method to wrap your child's residual limb:
- Hold the bandage roll on your child's thigh with one hand. Use the other hand to roll the bandage diagonally down the thigh. Stretch the bandage slightly when you get to the bottom of your child's limb. Wrap the bandage around the end of the limb.
- Roll the bandage around to the front. Continue diagonally up your child's thigh. The bandage will cross over itself. Roll the bandage all the way around the limb and to the front again.
- Repeat these steps until the limb is completely covered from mid-thigh down. Overlap the bandage as you wrap, so that you are always covering new skin. If you need to use more than one bandage, secure each bandage with a clip or tape before you apply the next.
- When you are finished, secure the last bandage. Try to end the bandage in a place that is not in a skin fold or at your child's knee joint.
Woolen residual limb socks:
Have your child wear woolen residual limb socks when healthcare providers say he or she no longer needs to wrap the residual limb. This keeps the residual limb clean and comfortable. Wash the woolen socks gently in cool water and soap to keep them from shrinking. Dry the socks flat on a towel to prevent stretching. Replace the sock if it gets torn.
- Have your child slowly increase his or her activity level. Your child should rest when needed but try to exercise 2 to 3 times each day or as directed by a healthcare provider. Do not let your child put weight on the residual limb until healthcare providers tell you it is okay. Many companies supply sports equipment for people with amputations. Talk to your child's healthcare provider about a prosthesis so he or she can stay active in sports.
- Ask your child's healthcare provider when your child can return to work or school. Ask when your adolescent can begin to drive.
For support and more information:
- Amputee Coalition
900 E. Hill Ave, Ste 290
Knoxville, , TN 37915
Phone: 1- 888 - 267-5669
Web Address: www.amputee-coalition.org
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