Video summary

Residual Limb Management - Prosthetic Training: Episode 1

Main summary

Key takeaways

Wellness and Self-Improvement

Key wellness & self-care strategies for residual limb management (prosthetic prep)

1) Control swelling (edema) with compression

Compression helps reduce fluid buildup and supports shaping for later prosthetic fit.

Rigid compression (less common post-op option)

  • Works well, but requires constant follow-up to prevent swelling from leading to wounds.

Soft compression (more common)

  • ACE wraps
    • Example (below-knee): double-length 4-inch ACE wrap
  • Shrinkers (often easier to use; choose based on swelling level + skin sensitivity):
    • Compressogrip (most common “middle” option)
    • Tru-Form (firmer/thicker)
      • Best for more swelling / “dog-ears” if the patient isn’t highly sensitive
    • Juzo (very light-weight/soft)
      • Best for minimal swelling and when the limb is very sensitive

How to put on a shrinker correctly (to protect the incision)

  • Do not drag or pull it up like a sock—protect the incision line (glue/sutures/staples/tape).
  • Roll it on from the center, like a stocking cap, and avoid rubbing over the incision.
  • Roll/finish fully up (no wrinkles/rolled spots), because those create fluid-trapping “tissue dams.”
  • Use proper layering/fit:
    • Don compression so it’s not too tight, and there’s no gap at the bottom.
    • If more compression is needed, add layers using the shrinker’s structure for gradient pressure to push fluid upward.

2) Protect the residual limb from falls/damage

  • Use a separate protection device (velcro style)
    • Purpose: prevent hospital readmissions due to falls
    • Important distinction: a protection device is not the same as a shrinker
  • The protection device can also help hold the residual limb into extension while staying comfortable.

3) Prevent contractures by improving positioning + range of motion

Avoid “comfortable but risky” bed positioning

Bed positioning may place the patient in:

  • Knee flexion
  • Hip flexion
  • External rotation
  • Abduction

Risk: over time, the joint may develop a contracture when not moved into adequate extension.

Bed positioning tweak

  • Keep the patient comfortable but reduce excessive support.
  • Use pillows/elevation adjustments so the residual limb is brought more into extension.
  • Minimize rotation/abduction to support neutral standing later.

Gentle exercise: move hip & knee through safe range (early, no pain-seeking)

  • Goal: keep joint oils moving, support joint health, and reduce contracture risk.
  • Routine guidance (especially when getting up):
    • At least about every hour in early stages:
      1. Roll to the sound side
      2. Do a simple cycle:
        • Slightly bend the knee and flex the hip only to comfort (don’t chase pain)
        • Then reach back to extend:
          • Extend the knee as much as possible
          • Extend the hip as much as possible (with guidance)
        • Repeat by gently bending back and extending again

4) Manage the incision line to support healing and future prosthetic comfort

Early incision goals (around ~2 weeks)

The incision must have:

  • Mobility
  • Protection
  • Tensile strength development (still developing; not fully reached yet)
Incision line “free movement” without strain
  • Place thumbs/fingers on both sides of the incision line.
  • Approximate gently and move thumbs together so the skin moves over underlying tissue.
  • Purpose: prevent invagination (scar adhering down so skin can’t glide/shear properly later inside the socket).

When more tensile strength is available (after ~3 weeks / about 60% attainable tensile strength)

  • Progress from “approximate” to mobilize with shear:
    • Allow thumbs to move separately to create controlled shear across the incision line.
  • Skin flaking from healing can be normal/good.

Further progression

  • When appropriate, place fingers directly on/near the incision and use circular motions to maintain loosening of the shearing plane.

How long to mobilize

  • Usually mobilize for at least ~6 weeks.
  • Stop when the lump/epithelial line feels flush and the area under the incision no longer feels prominent.

Patient involvement

  • Once the wound is stable and not heavily bandaged, teach the patient to mobilize themselves:
    • Improves regular movement
    • Helps them interact with the residual limb
    • May reduce phantom limb fear/concerns

Skin care during healing

  • If incision is closed, lotion/cocoa butter can help with thick/scarred areas.
  • Do not apply lotions/lubricants to anything with an open wound (not antiseptic).

5) Reduce secondary risks in bed: heel pressure + edema control

Prevent heel pressure / stasis ulcers

  • Unload the heel so it comes off the end of the pillow (enough to show heel loading/unloading).
  • Helps especially if there’s reduced sensation/peripheral neuropathy.

Manage edema that worsens after getting up

If swelling increases at the ankle after standing/wheelchair use (venous return issues):

  • Consider compression garments (e.g., knee-high TED hose)

Donning/doffing technique (to protect skin + prevent dragging):

  1. Roll garment halfway out
  2. Put foot in first
  3. Roll all the way up

Presenters / sources

  • Presenter: David Lawrence (host/speaker)

Original video