Amputation: stump care, positioning against contractures, phantom pain and getting ready for a prosthesis
- Safe practice
After an amputation the nurse protects the wound, shapes the stump, prevents joint contractures, treats phantom pain and supports the person.
What it is
After a limb amputation, nursing care looks after the wound and the residual limb (stump), controls swelling so the stump takes a cone shape that fits a prosthesis, prevents hip and knee contractures that would make walking with a prosthesis hard, and manages pain, including phantom limb pain, which is very common. It also covers safe transfers and the grief, anger or sadness that are normal after losing a limb. In patients with diabetes, good glucose control supports healing.
What it requires
- Wound care with the dressing ordered, and stump shaping with bandage, shrinker or rigid dressing.
- Positioning and exercises to keep the hip and knee straight.
- Assessment of stump pain and phantom pain.
- Practice of transfers and the walker or wheelchair before discharge.
- Emotional support for the patient and family.
How it is applied (and why)
- Check the wound and the dressing, and the colour and warmth of the skin of the stump — dark skin, new drainage or bleeding need early action.
- Keep the stump straight lying and sitting, with no pillow under it; use a board below the knee — flexion contractures block walking with a prosthesis.
- Encourage prone lying several times a day after an above-knee amputation, if allowed — it stretches the hip flexors.
- Keep the stump aligned with rolled towels and teach not to cross the legs — rotation and crossing cause deformity and reduce blood flow.
- Apply the elastic bandage or shrinker as ordered, tighter at the end than at the top, and rewrap without creases — this controls swelling and shapes a cone.
- Ask about stump pain and phantom pain separately; give ordered relief plus gentle tapping or massage of a healed stump — phantom pain can be treated.
- Practise transfers and walker or wheelchair use with the team — safe mobility prevents falls on the remaining limb.
- Once healed, wash the stump daily with mild soap, dry it well, do not soak it and inspect it — skin breakdown delays prosthesis use.
- Listen to the patient, involve the family and offer referral if low mood persists — sadness and anger are normal, but depression needs help.
In nursing practice
- Spreading redness, red streaks, warmth, swelling, pus or a foul smell suggest wound infection.
- Dark or black skin on the stump suggests tissue death and needs urgent review.
- Hip flexion, abduction and external rotation contractures after above-knee amputation, and knee flexion contracture after below-knee amputation.
- Phantom limb pain is common and often neuropathic; mirror therapy is one of the commonly used treatments.
- Swelling left untreated can cause discolouration, blisters or ulcers on the stump.
Common mistakes
- Putting a pillow under the stump for comfort.
- Leaving the patient sitting for long periods with the hip and knee bent.
- Wrapping the stump with creases or tighter at the top than at the end.
- Dismissing phantom pain as imaginary.
- Not rewrapping the bandage when it loosens or creases.
Test yourself
Think of the answer, then tap the question to see it.
Why is a pillow not placed under the stump after a leg amputation?
It keeps the hip or knee bent and leads to flexion contractures that make walking with a prosthesis difficult.
How is an elastic bandage applied to a leg stump?
Tighter at the end than at the top, without creases, and rewrapped often as ordered, to control swelling and shape a cone.
Is phantom limb pain real?
Yes. It is common after amputation, is often neuropathic, and is assessed and treated like any other pain.
Which stump findings must be reported?
Spreading redness or red streaks, warmth, swelling, new drainage or bleeding, a foul smell, fever, or dark or black skin.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Leg amputation - discharge, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Choo YJ, Kim DH, Chang MC. Amputation stump management: a narrative review. World J Clin Cases 10(13):3981-3988 (World Journal of Clinical Cases (PubMed Central, open access), 2022).
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Representative model, for educational purposes only.