PHYSICAL THERAPY FOR RESIDUAL LIMB SCAR AFTER TRANSTIBIAL AMPUTATION

Abstract

The article considers a comprehensive approach to physical therapy and management of the postoperative scar in patients following transtibial amputation (at the below-knee level). The author provides a detailed analysis of the direct impact of the morphological state of soft tissues on the subsequent prosthetic process, adaptation to the prosthetic socket, and the patient’s overall functional mobility. Special attention is paid to the pathophysiological aspects of scar tissue formation, which, under the conditions of a lower leg residual limb, is subjected to specific mechanical stresses such as pressure and shear forces. The article highlights in detail the techniques of scar tissue mobilization aimed at preventing the formation of adhesions with the tibial periosteum and deep fasciae. This is a critical factor for creating mobile skin coverage, which minimizes the risk of trophic ulcers and ensures painless use of the prosthesis. The following physical therapy methods applied are described: compression therapy, lymphatic drainage massage, physiotherapy, and therapeutic exercises. As part of the study, an evaluation of the effectiveness of the implemented physical therapy program was conducted for a group of patients with transtibial amputations of various etiologies. The program included early mobilization of soft tissues, compression therapy, and a system of exercises for the prevention of knee joint contractures. The results confirmed a positive dynamics: patients showed accelerated formation of a stable residual limb volume, a decrease in the intensity of phantom limb pain, and higher tolerance to loads during primary prosthetic fitting. Systematic physical therapy of the scar allows for the formation of a functional residual limb that is resistant to mechanical irritation and the aggressive environment inside the prosthetic socket. It is proven that early initiation of soft tissue management is the key to a significant reduction in the time required for prosthetic preparation, a decreased risk of repeated surgical interventions, and a substantial improvement in the patient’s quality of life in the long term