Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XXI: Amputations
United States Department of Defense
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To prevent flexion contracture of the hip following transfemoral amputations, the patient should be kept in the prone position as much as possible until he has become familiar with active range of motion exercises. When he lies supine, sandbags should be used to hold the stump in position. A tourniquet should be readily available for emergency use during the first 5-7 postoperative days. It should be loosely attached to the bed or to the litter during evacuation.
Prior to amputation, or as soon as the patient becomes conscious postoperatively, the patient should be counseled that he will experience both normal and painful sensations in the phantom limb. This counseling is critical to allay apprehension and prevent fear which can drain the postoperative patient's energy for recovery. There is frequently severe causalgia-like pain in the end of the residual limb which subsides with healing. The patient should be told that this is normal and will subside soon. Adequate pain medication should be provided as required for stump pain.
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