After an amputation, the part of the arm or leg that remains once a segment of the limb has been surgically removed is called a stump. In modern medical and rehabilitation terminology the term «residual limb» is also widely used.

The condition of the residual limb is of great importance for a person’s further recovery. How the surgical wound heals, how the swelling subsides, how the scar forms, how joint mobility is preserved and how the volume of the tissues changes all largely determine whether a prosthesis can be used comfortably.

What is a residual limb after amputation

The residual limb is the part of the limb that remains after amputation. It includes bone structures, muscles, blood vessels, nerves, subcutaneous tissue and skin.

For example:

• after amputation of the leg below the knee, a transtibial residual limb remains;
• after amputation above the knee — a transfemoral residual limb;
• after amputation of the arm below the elbow — a transradial residual limb;
• after amputation above the elbow — a transhumeral residual limb.

Depending on the level of amputation, the condition of the tissues and the reason for surgery, the length and shape of the residual limb differ considerably from patient to patient.

It is the residual limb that interacts with the socket of the future prosthesis, so its condition directly affects the comfort, suspension and functionality of the prosthetic system.

How the residual limb takes shape

The residual limb does not take its final shape immediately after surgery.

In the first days and weeks after amputation there is usually postoperative swelling. As the tissues heal and the body recovers, the volume of the residual limb gradually decreases and changes.

This process is known as shaping or maturation of the residual limb.

Several important processes take place after surgery:

• the surgical wound heals;
• the swelling subsides;
• the postoperative scar forms;
• the volume of soft tissue changes;
• the muscles adapt to the new conditions;
• sensitivity gradually returns;
• the body adapts to the change in biomechanics;
• the tissues are prepared for the future load inside the prosthesis.

What a residual limb looks like after amputation

Immediately after surgery the residual limb usually looks different from how it will look several months later.

In the early postoperative period the following may be present:

• swelling;
• a change in skin colour;
• surgical sutures or staples;
• a postoperative dressing;
• increased sensitivity;
• tenderness;
• a feeling of tightness in the tissues.

As the wound heals, the swelling gradually subsides and the shape of the residual limb changes.

The task of the rehabilitation team is to help reach a state in which the tissues are ready for contact with the prosthetic socket and for gradual loading.

Which residual limb is considered ready for prosthetic fitting

There is no single universal «ideal» shape of the residual limb.

Modern technology makes it possible to fit patients with very different levels and features of amputation. However, certain characteristics make the selection and use of a prosthesis easier.

Before prosthetic fitting begins, specialists assess:

• healing of the surgical wound;
• the condition of the skin;
• the condition of the postoperative scar;
• the degree of swelling;
• the shape and volume of the residual limb;
• tenderness;
• sensitivity;
• the range of motion in the joints;
• muscle strength;
• the presence of contractures;
• the patient’s general physical condition.

The postoperative scar on the residual limb

Once the surgical wound has healed, a scar remains.

For future prosthetic fitting it is important to assess:

• its location;
• its mobility;
• tenderness;
• the condition of the surrounding skin;
• the presence of adhesions to deeper tissues.

A scar that is too sensitive or poorly mobile sometimes causes discomfort when the socket is worn.

Once the wound has closed completely and with the permission of the specialists, scar work, massage and desensitisation techniques may be added to the rehabilitation programme.

What is desensitisation of the residual limb

After an amputation, touching the residual limb may feel unusual or unpleasant.

Desensitisation is the gradual adaptation of the tissues and the nervous system to touch and to different kinds of stimulation.

Depending on the stage of recovery, a specialist may recommend gradually introducing:

• light touch;
• gentle rubbing;
• different textures;
• massage;
• light tapping;
• gradually increasing contact with fabrics and with the future components of the prosthesis.

This preparation can make the later contact between the residual limb and the socket more comfortable.

Pain in the residual limb after amputation

After an amputation a person may experience different kinds of sensations.

It is important to distinguish between:

Residual limb pain and phantom pain are different conditions, and the approach to treating them may differ.

How to care for the residual limb

Proper care of the residual limb is necessary not only in the first weeks after surgery. It remains important once the prosthesis is in use as well.

Once the wound has healed completely, it is generally recommended to keep the skin clean and to inspect the residual limb every day.

Pay particular attention to:

• redness;
• chafing;
• cracks;
• blisters;
• areas of increased pressure;
• skin damage;
• discharge;
• unpleasant odour;
• increased swelling.

The skin must be kept clean and dried thoroughly after washing. If a person is already using a prosthesis, the components of the prosthetic system that touch the skin also require regular hygiene.

Why the residual limb must be inspected every day

The prosthetic socket is in direct contact with the residual limb.

If the fit is incorrect or the volume of the residual limb changes, excessive pressure or friction may occur in certain areas.

This may result in:

• redness;
• irritation;
• calluses;
• blisters;
• open sores;
• inflammation.

If unfamiliar pain appears while the prosthesis is being used, it is advisable to take it off and check the condition of the skin. Persistent, painful or recurring damage should be assessed by a specialist and a prosthetist.

Why changes in residual limb volume must not be ignored

The volume of the residual limb is not entirely constant.

It changes especially noticeably during the first months after amputation, as the postoperative swelling gradually subsides.

Because of this, a socket that used to fit well may over time become too loose or start creating pressure in certain spots.

During the initial fitting period the following may therefore be needed:

• changing the number of prosthetic socks;
• adjusting the suspension components;
• modifying the socket;
• manufacturing a new socket.

What a contracture is and why it interferes with prosthetic fitting

A contracture is a persistent restriction of joint mobility caused by shortening or altered condition of the muscles and other soft tissues.

After a lower limb amputation it is especially important to maintain the correct position of the hip and knee joints.

For example, if a person spends long periods only in a seated position with the leg bent, some muscles may gradually shorten.

A pronounced contracture can make the following more difficult:

• putting the prosthesis on;
• correct alignment of the components;
• standing;
• walking;
• maintaining balance;
• developing a correct movement pattern.

This is why exercise and correct positioning are an important part of rehabilitation after amputation.

What happens to the residual limb after the first prosthesis

Receiving a prosthesis does not mean that the shaping of the residual limb is complete.

Once walking begins or the prosthesis is used actively, the load on the tissues changes. The volume of the residual limb may also continue to decrease.

That is why the first period of prosthetic use often requires especially close cooperation with the prosthetist.

The specialist assesses:

• suspension of the prosthesis;
• pressure distribution;
• the condition of the skin;
• the position of the residual limb inside the socket;
• changes in volume;
• comfort during movement.

Where necessary, the prosthetic system is adjusted and modified.

What problems can occur with the residual limb

Most problems can be managed effectively if specialists are consulted in good time.

Possible complications include:

• prolonged or pronounced swelling;
• skin irritation;
• chafing;
• open wounds;
• inflammation;
• infection;
• a painful scar;
• heightened sensitivity;
• neuroma;
• contractures;
• chronic pain;
• difficulty keeping the prosthesis suspended;
• significant changes in residual limb volume.

The residual limb itself is not always the cause of discomfort when using a prosthesis. Sometimes the problem lies in the socket fit, the setup of the prosthesis or a change in tissue volume.

Is prosthetic fitting possible with a difficult residual limb

In many cases — yes.

Modern prosthetics is not limited to patients whose residual limb has a «standard» shape.

Specialists work with patients:

• after high-level amputations;
• after traumatic amputations;
• with a short residual limb;
• after repeat surgery;
• with an unusual residual limb shape;
• after bilateral amputations;
• with complex scarring and other tissue characteristics.

In such situations a custom socket design, the right choice of suspension system and comprehensive rehabilitation are especially important.

Whether prosthetic fitting is possible, and how it should be approached, is determined by specialists after examining the patient.

Why the socket is so important

The socket is one of the key elements of a prosthesis.

It is inside the socket that the residual limb sits.

The socket must:

• hold the residual limb securely;
• distribute the load correctly;
• take anatomical features into account;
• allow the prosthesis to be controlled;
• avoid excessive pressure on sensitive areas;
• provide stability during movement.

This is why making a prosthesis always starts with a careful assessment of the residual limb.

Frequently asked questions about the residual limb after amputation

How long does a residual limb take to heal after amputation?

The recovery time is individual. It depends on the reason for the amputation, the level of surgery, the state of the blood vessels and tissues, the patient’s general health and any co-existing conditions.

For this reason, going by the number of days or weeks since surgery alone is not the right approach.

Why does the residual limb get smaller?

After an amputation the postoperative swelling gradually subsides and the soft tissues adapt to the new conditions. That is why the volume of the residual limb can change noticeably during the first months.

Does the residual limb need to be bandaged?

Compression therapy is indeed used to control swelling and shape the residual limb. However, the method of compression must be prescribed and demonstrated by a specialist. Incorrect bandaging done on your own can create uneven or excessive pressure.

Can the residual limb be massaged?

Once the wound has healed completely, massage and scar work may be part of the rehabilitation programme. Such procedures should only begin with the permission of the treating specialist.

Why has the prosthesis started to chafe when everything used to be fine?

One possible reason is a change in the volume of the residual limb. The socket or other components of the prosthesis may also need adjusting.

If the chafing keeps coming back, you need to see your prosthetist.

Is it normal to feel the amputated arm or leg?

Phantom sensations after amputation are common. A person may feel the position or movement of the part of the limb that is missing.

If these sensations come with significant pain, this should be discussed with a doctor.

Is prosthetic fitting possible with a short residual limb?

Whether a prosthesis can be fitted depends on more than the length of the residual limb. The level of amputation, the condition of the tissues and joints, muscle strength, skin condition and the patient’s functional abilities are all taken into account.

With an unusual or short residual limb, an individual assessment by the prosthetist and the rehabilitation team is required.

What should I do if a sore appears on the residual limb?

You should temporarily remove whatever is traumatising that area and consult a specialist. It is especially important not to keep using the prosthesis through pain or over clearly damaged skin without finding out the cause.