Amputation Site Wound Care in St. Louis

Healing after a toe, foot or leg amputation

An amputation is surgery, and the place where the surgeon closed the tissue is a surgical wound. Amputation site wound care is the follow-up that helps that wound close and stay closed, so that rehabilitation, footwear or a prosthesis can move ahead.

Diabetes, poor circulation and severe infection are common reasons for losing a toe, part of a foot or a leg. Those conditions are still present after surgery and can slow healing at the new site.

If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.

Why amputation sites can be slow to heal

Clinicians call the remaining part of the limb the residual limb. Its incision may be closed with stitches or staples, or part of it may be left open on purpose to heal from the inside. Several things can get in the way:

Reduced blood flow to the area
High or widely swinging blood sugar
Swelling in the residual limb
Infection in the skin or bone
Pressure, rubbing or a fall onto the site
Poor nutrition, smoking and kidney disease

If the edges of the incision separate, the wound is called dehisced, and our page on dehisced surgical wounds explains what that means.

How needs differ by amputation level

Toe and partial foot amputations

Losing a toe or part of the forefoot changes how weight travels across the foot. New pressure points appear, often on a foot that already has reduced feeling. The clinician and podiatrist may order offloading for the foot wound, followed by shoes or inserts made for the new shape of the foot.

Below-knee and above-knee amputations

With a leg amputation, the goal is a well-healed, well-shaped limb. The surgeon or prosthetist may order a compression garment or wrap to control swelling. The therapy team teaches positioning and safe transfers, because a fall onto a fresh incision is one way these wounds reopen.

What the treating clinician checks

At each visit, the treating clinician checks:

Whether the incision edges are together and how any open areas are changing
Skin color and temperature, which give clues about blood flow
Drainage, odor, warmth and other signs of infection
Swelling, and how any wrap, garment or protective device fits
Pain that is new or different
The other foot and leg

The clinician writes the wound orders and tells the surgeon about any concern. Removal of stitches or staples and decisions about putting weight on the limb stay with the surgeon.

One plan across surgeon, prosthetist and therapy

Recovery after amputation involves several offices.

The surgeon owns the surgical plan and decides when the site is ready for the next step.
The prosthetist fits and adjusts a prosthesis once the site is ready.
Physical and occupational therapists work on strength, balance, transfers and daily tasks.
Your primary care clinician manages diabetes, blood pressure and medicines that affect healing.

Gateway coordinates communication among them. When the treating clinician changes the dressing plan or sees a setback, we help get that information to the surgeon, the therapy team and the prosthetist, so a fitting is not planned for a limb that is not ready.

The remaining foot needs protection too. Gateway can coordinate limb preservation follow-up when the clinician recommends it.

Changes to report and when to call 911

Tell the treating clinician or surgeon promptly about:

An incision that opens, even slightly
New drainage, pus or odor
Redness, warmth or swelling that is spreading
Skin at the site turning dusky, purple or black
Fever or chills
A fall or hard bump to the site
Blisters or sores under a wrap, garment or prosthesis
Any new sore on the other foot

Call 911 for heavy bleeding that does not stop with firm pressure, chest pain, trouble breathing, confusion or fainting. Gateway is not an emergency service.

How Gateway arranges amputation site wound care

Many people go from the hospital to a rehabilitation center or skilled nursing facility and then home. Gateway arranges visits with partner clinicians in each of those settings across Greater St. Louis and the Metro East, so wound follow-up does not lapse with each move. Our page on wound follow-up after hospital discharge describes how that handoff works.

Patients and families can call 314-325-0126, with or without a referral, or request care with a name and phone number. Surgeons, discharge planners and facilities can refer a patient. Availability is confirmed for each location and care setting. Participation and benefits depend on the treating provider, your plan and the care needed.

Common questions

When can I be fitted for a prosthesis?

Your surgeon and prosthetist decide, and it depends on how the site heals. In general they want the wound closed, the swelling settled and the skin able to tolerate pressure. An open area or an infection usually delays fitting. Ask the surgeon what they need to see first.

Is it normal to feel pain in the part of the limb that is gone?

Many people feel sensations, including pain, that seem to come from the missing part. This is called phantom sensation or phantom pain, and it is different from pain at the incision. Tell your surgeon or primary care clinician about it, because there are ways to address it.

What should I do if I fall or bump the amputation site?

Look at the site, or have someone look for you, and report the fall to the surgeon or treating clinician even if the dressing looks fine. A fall can open an incision or cause bleeding under the skin that shows up later. Call 911 for heavy bleeding, severe pain, or if you cannot get up safely.

Why does my other foot need attention too?

Diabetes, nerve damage and circulation problems usually affect both legs. After an amputation, the remaining foot also does more work during transfers and standing. A small blister or callus there can become a serious wound. Ask your clinicians about daily foot checks, footwear and regular foot exams.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Amputation site wound care in St. Louis.