Amputation Care

Whether you’ve experienced limb loss from a traumatic injury, cancer, infection, diabetes, vascular disease or a congenital (born with it) condition, recovery after amputation takes time and can be challenging. Having a plan for what comes next is key. Our team will help you prepare for life after surgery. We provide:

Emotional support

Losing a limb can sometimes trigger depression, post-traumatic stress disorder (PTSD) and other mental health conditions. If that happens, we can connect you and your family members with mental health providers before and after surgery. We want to help you get ready for treatment — and pave the way to a smoother recovery.

Infection prevention

Infection is a serious amputation complication. It can keep your wound from healing correctly and damage healthy tissue. This can sometimes mean a longer hospital stay or more surgery. Before you even go into the operating room, our infectious disease specialists will create a plan to prevent infection — which may include taking antibiotics before and after your surgery.

Wound care

After amputation, your care team shows you and your support person how to clean and care for your wound. Taking care of your incision properly will help prevent infection and keep the remaining part of your limb (residual limb) healthy. Your wound also needs to be fully healed before you can wear an artificial limb (prosthesis).

Pain management

After surgery, we may provide continuous pain medication through an intravenous (IV) infusion (through a vein in your arm) while you recover in the hospital. Our pain management specialists will talk with you about how to control pain once you leave the hospital (usually within a week or two after surgery).

We’ll also set up a pain management plan for you to follow as you recover. It’s common to have real residual limb (stump) pain where the amputated limb used to be. We call this phantom limb pain, which nervous system signals can trigger. You may also have pain from neuromas (thickened nerve tissue), or from rehabilitation or adjusting to a prosthesis. Pain management is an important part of your amputation care plan.

Meet Our Amputation Care Team

At Cleveland Clinic, you’ll have a team of providers working together to make sure you get the best amputation care. We start planning your care before surgery to help you have the smoothest possible recovery. Throughout your journey, you can reach out to your care team with questions and concerns. Your team may include:

• Orthopaedists.
• Vascular surgeons.
• Internists (providers who specialize in treating common adult medical problems).
• Infectious disease specialists.
• Pain management specialists.
• Physiatrists (physical medicine and rehabilitation specialists).
• Physical therapists.
• Occupational therapists.
• Psychologists.
• Social workers.
• Nurse practitioners.
• Prosthetists (prosthetic limb specialists).

One of the most important parts of your recovery is physical rehabilitation. We want to help lessen your pain and rebuild your emotional and physical strength, so you feel confident about moving forward as independently as possible.

Because rehab is so crucial to your recovery, we start therapies while you’re still in the hospital. Our therapists teach you to:

• Move and position your residual limb to help your wound heal.
• Strengthen and stretch your residual limb to prepare it for a prosthesis in the future.
• Use a wheelchair and other assistive devices to reduce your fall risk and help you move better.

Ongoing therapy

Before you leave the hospital, we help you and your family decide where you’ll continue recovery. If you need additional wound care, you may go to an acute care hospital, skilled nursing facility or a rehabilitation hospital for a bit. Or you might have rehab at home or go to a physical therapy center a few times each week.

No matter where you choose to recover, our physical and occupational therapists will take a close look at your amputation area. They’ll also check your overall health and talk with you about your mobility goals. Throughout rehab, they’ll work with you at your pace, focusing on improving your balance, strength and flexibility. Your therapy team can help you:

• Learn to use assistive devices, like wheelchairs, walkers, crutches or a cane.
• Teach you how to safely do everyday activities, like dressing or using the toilet.
• Help you gradually get back to hobbies you enjoy, including outdoor activities.
• Learn to use an artificial limb if you’d benefit from one.

Using a prosthesis

If you’d benefit from using a prosthesis, we’ll go over the types that’ll work for your amputation. We’ll measure you for a prosthesis when your wound has healed, and your residual limb is “shaped.” Shaping means we reduce swelling with a compression stocking. The stocking shrinks your residual limb so it can fit into the socket of a prosthesis.

After your fitting, our prosthetists will design a customized everyday limb using the newest software. We can also provide sport- or activity-specific prosthetics.

Your physical rehabilitation team helps you learn to use and care for your new limb. They’ll teach you how to:  

• Balance, bear weight and walk with your prosthesis.
• Care for your residual limb to prevent skin irritation from the prosthesis.
• Put on and remove your prosthesis.
• Recognize when your prosthesis needs to be repaired, adjusted or upgraded.

Procedures and surgeries after amputation

At Cleveland Clinic, we specialize in surgical techniques to reduce pain and help you move better after an amputation. Procedures include:

• Osseointegration: We implant a metal device into the remaining bone of the residual limb extending directly out of your skin. This portion of bone connects directly with the prosthetic limb which makes the prosthesis easier to use. This may be an option if you’ve had an amputation but haven’t had good results using a socket prosthesis.
• Targeted peripheral nerve interface (TPNI): This surgery involves doing a TMR and then wrapping a muscle graft (the RPNI) from the around the sensory nerve to motor nerve connection.
• Regenerative peripheral nerve interface (RPNI): RPNI is basically a muscle graft of tissue that we attach to the end of a cut nerve. The muscle graft then becomes innervated (bring sensation to). These muscle grafts can also show up on an EMG and may help support a bioelectric prosthetic.
• Targeted muscle reinnervation (TMR): With TMR, we take cut sensory nerve endings (thought to be the main cause of neuroma pain) and re-route them into motor nerves. The motor nerves can stimulate the muscle that they are already attached to and can be used to stimulate a bioelectric prosthetic. 

Both RPNI and TMR are surgical techniques to handle neuroma pain after an amputation. Think of sensory nerves as live electric wires and re-directing the ends of these wires can give the nerve “something to do.” This can help prevent a neuroma from forming and help with pain related to the formation of a neuroma. Both techniques also have the capability to help stimulate bioelectric prosthetics.

Taking the Next Step

It may be hard to see the road ahead after losing a limb. And you probably have many questions, concerns and emotions swirling around in your head. But with the support and expertise of your dedicated Cleveland Clinic care team, you’ll have the power and confidence to move forward to this next phase of your life. As you recover, we provide amputation care at your pace, on your terms, not just today but also tomorrow — and beyond.