8.14 Managing stump (residual limb) complications There is continuing discussion on the most appropriate term for the residual limb. Health professionals often use the phrase ‘residual limb’, although others think that this term refers to a remaining and intact limb. Following the advice from people with lived experience involved with the guidance development and in the interests of person-centredness, we use the word stump. All people experiencing a limb amputation have changes to the stump over time and care of the stump is a continuous process [106]. Stump changes are more pronounced in the first one to three years after amputation, particularly changes in the stump shape and volume; changes also depend on the site of amputation, and whether it is an upper or lower limb amputation. There are also likely to be stump changes from day to day (e.g. in hot versus cold weather, or related to activity level). These changes may occur throughout the person’s life.
Also women with a limb amputation may experience changes to the stump during their pregnancy e.g. swelling [107]. Each person needs to seek support and advice from the multidisciplinary team and their peers on how to manage these changes. Often there are other more significant concerns and potential issues with the stump that mean the person needs support and advice. These include [108-111]:
• • • • •
trauma from falls
• • • • •
spur formation
changes to the shape and volume of the stump complications with wound healing phantom limb pain (refer to Section 9.4 Pain) flap necrosis or infection (refer to Section 9.5 Infections) skin breakdown development of neuroma contact dermatitis phantom sensation.
Some of these issues require the person to be re-admitted to hospital for treatment.
Best practice note—11 Stump complications
LC0063_Guidance_on_the_support_pathway_v10
It is important that the person, their family, the multidisciplinary team (including the GP) and the funder recognise the impacts of potential stump issues. These issues can impact the person’s progress on the pathway at any phase. For example, delay in fitting the prosthesis heightens the need for trialling componentry and could result in a change in support needs, or further treatment and rehabilitation. Accordingly, there may be requests to the funder for changes to, or additional, treatment and equipment (e.g. a change to the socket).
© icareTM | Insurance and Care NSW 2021
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icare Guidance for people with a limb amputation 2021
