From the Guidelines
Oedema in a stump should be managed with a combination of elevation, compression, and physical therapy to reduce swelling and promote healing. When evaluating a patient with oedema in a stump, it is essential to assess the affected limb for arterial ischemia, venous insufficiency, and other factors that may be contributing to the swelling, as recommended by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. Elevate the residual limb above heart level when resting to promote fluid drainage. Apply compression using elastic bandages, shrinker socks, or a properly fitted prosthetic socket to reduce swelling, and begin with gentle compression and gradually increase as tolerated.
Some key considerations when managing oedema in a stump include:
- Physical therapy exercises, including gentle range of motion and muscle contractions, to help improve circulation and reduce fluid accumulation
- Massage the stump in an upward direction to facilitate fluid movement
- Ensuring proper wound care if the stump has surgical sites, and monitoring for signs of infection such as increased redness, warmth, or pain
- Regular monitoring is essential as chronic swelling can lead to skin breakdown, delayed healing, and difficulties with prosthetic fitting
It is also crucial to assess for neuropathy, especially the loss of protective sensation, using a 10-g nylon monofilament (Semmes-Weinstein 5.07) as recommended by the guideline 1. If oedema persists despite these measures, consult a healthcare provider as it may indicate underlying issues like infection, venous insufficiency, or heart failure. In some cases, diuretics like furosemide 20-40mg daily may be prescribed, but only under medical supervision as they can cause electrolyte imbalances. Determining the ratio of systolic blood pressure in the ankle to the systolic blood pressure in the brachial artery (ABI) using sphygmomanometers and a hand-held Doppler machine can help assess for peripheral arterial disease (PAD), which may be present in up to 40% of patients with diabetic foot infections 1.
From the Research
Oedema in a Stump: Management and Treatment
- Oedema in a stump can be managed through various methods, including clean wound or edema management of the stump to prevent problems associated with wearing a prosthesis 2.
- Compression therapy can be used to reduce chronic edema of the extremities, with optimal pressure depending on the individual case 3.
- Leg elevation can be used as a form of intervention in the treatment of chronic peripheral oedema, but it is crucial to establish the cause of the oedema to decide on the most appropriate intervention for its management 4.
Causes of Oedema
- Certain medications, such as ibuprofen, can be associated with salt and water retention, leading to edema 5.
- It is essential to review the patient's medication regimen to identify potential causes of oedema.
Treatment Options
- Pharmacologic management of acute pain, including the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), can be tailored for each patient, but it is crucial to consider the potential risks and side effects of these medications, including edema 6.
- Adjunctive medications may be added as appropriate for specific conditions, but it is essential to minimize the risk of opioid medications and consider alternative treatment options.