Last updated: 11/24/2009

During the five to 10 days the patient remains in the hospital following surgery, nurses monitor sensation and blood flow in the affected extremity and watch for signs that the patient may be developing pneumonia, pulmonary embolism, or deep-vein thrombosis.

The...

doctor prescribes broad-spectrum antibiotics for at least the first 48 hours after the operation and often prescribes medication (prophylactic anticoagulants) and antiembolism stockings to prevent blood clots. A drainage tube placed in the wound for the first 24–48 hours prevents blood (hematoma) and fluid (seroma) from accumulating at the surgical site. As postoperative pain becomes less intense, mild narcotics or anti-inflammatory medications replace the epidural catheter or patient-controlled analgesic pump used to relieve pain immediately after the operation.

Exercise intervention

Limb salvage requires extensive surgical incisions, and patients who have these operations need extensive rehabilitation. The amount of bone removed and the type of reconstruction performed dictate how soon and how much the patient can exercise, but most patients begin muscle-strengthening, continuous passive motion (CPM), and ROM exercises the day after the operation and continue them for the next 12 months.

A patient who has had upper-limb surgery can use the opposite side of the body to perform hand and shoulder exercises. Patients should not do active elbow or shoulder exercises for two to eight weeks after having surgery involving the bone between the shoulder and elbow (humerus). Rehabilitation following lower-extremity limb salvage focuses on strengthening the muscles that straighten the legs (quadriceps), maintaining muscle tone, and gradually increasing weight-bearing so that the patient is able to stand on the affected limb within three months of the operation. A patient who has had lower-extremity surgery may have to learn a new way of walking (gait retraining) or wear a lift in one shoe.

Goals of rehabilitation

Physical and occupational therapy regimens are designed to help the patient move freely, function independently, and accept changes in body image. Even patients who look the same after surgery as they did previously may feel that the operation has altered their appearance.

Before a patient goes home from the hospital or rehabilitation center, the doctor decides whether the patient needs a walker, brace, cane, or other device, and should make sure that the patient can climb stairs. Also, the doctor should emphasize the life-long importance of preventing infection and give the patient written instructions about how to prevent and recognize infection, as well as what steps to take if infection does develop.