Assessment Protocol for 1-Month Follow-up After Below-Knee Amputation
At the 1-month follow-up visit for a below-knee amputation in vascular surgery clinic, a comprehensive assessment of wound healing, vascular status, functional recovery, and cardiovascular risk factors is essential to optimize outcomes and prevent complications.
Wound and Stump Assessment
- Wound healing status: Evaluate for complete closure, presence of dehiscence, infection, or drainage 1
- Stump shape and volume: Check for proper contouring, edema, or shrinkage
- Skin condition: Assess for signs of pressure areas, skin breakdown, or irritation
- Transcutaneous oxygen tension (TcPO2): Values >40 mm Hg around the amputation site predict successful healing 1
- Suture line integrity: Evaluate for proper healing without tension
Vascular Assessment
- Palpation of femoral and popliteal pulses: Document presence and quality
- Ankle-Brachial Index (ABI) or Toe-Brachial Index (TBI): Perform to evaluate arterial perfusion 1
- Duplex ultrasound (DUS): Should be performed within 4-6 weeks after revascularization to establish a baseline 1
- Signs of recurrent ischemia: Assess for pain, pallor, or temperature changes
Functional and Mobility Assessment
- Prosthetic fitting status: Determine readiness for definitive prosthesis if using temporary prosthesis
- Socket fit: Evaluate for proper fit without excessive pressure points if already using a prosthesis
- Gait analysis: Assess ambulation pattern if patient has begun walking
- Residual limb pain: Document presence, character, and severity of any pain
- Phantom limb sensations: Document and address if present
Cardiovascular Risk Factor Management
- Blood pressure control: Measure and optimize management
- Lipid profile: Review recent results and adjust therapy as needed
- Diabetes management: Check glycemic control if applicable
- Smoking status: Reinforce cessation if applicable
- Medication adherence: Review and reinforce antiplatelet, statin, and other cardiovascular medications
Contralateral Limb Assessment
- Skin integrity: Check for ulcers or pressure points
- Pulses: Document presence and quality
- Sensory function: Assess for neuropathy
- Footwear: Evaluate appropriateness and fit
Rehabilitation Progress
- Range of motion: Assess hip and knee joint mobility of the amputated limb
- Muscle strength: Evaluate residual limb and core strength
- Transfer abilities: Assess independence with transfers
- Activities of daily living: Document level of independence
Follow-up Planning
- Schedule next visit: Typically at 3 months post-amputation 1
- Coordinate multidisciplinary care: Ensure proper communication with rehabilitation team, prosthetist, and primary care
- Wound care instructions: Provide specific guidance if wound is not completely healed
- Red flags: Educate patient about signs requiring immediate attention (increased pain, drainage, fever)
The European Society of Cardiology guidelines recommend regular follow-up after revascularization, with assessment of clinical, hemodynamic and functional status, limb symptoms, treatment adherence, and cardiovascular risk factors 1. Transcutaneous oxygen tension (TcPO2) values >40 mm Hg in the area surrounding the amputation site are considered predictive of successful healing 1, making this an important parameter to evaluate at the 1-month follow-up visit.