Amputation after Burn Injury

Introduction

Amputation is the whole or partial loss of a body structure (leg, arm, finger, ear, etc.). Amputation after a burn injury is rare, but it does occur in around 2% of burn survivors. Amputation may help to improve function after a severe burn injury because the patient does not need to go through many years of debridement, limb-salvaging surgeries, and pain.

Why Is Amputation Needed?

Many amputations result from a physically traumatic event, such as a burn injury. People with severe heat and electrical burns are at higher risk of amputation. Severe burns increase the chance of the following:

• Limbs, digits, or other body parts (e.g., nose, ears, eyes) are no longer functional or do not respond to surgical or therapeutic interventions.
• Sepsis, which is a severe blood infection.

An amputation can remove infection and improve healing, the chance of survival, and the chance of better outcomes in some patients. Sometimes patients and family members must make the difficult decision about whether amputation is the right choice for them. Clinicians can provide guidance and support to help them navigate this decision.

What to Expect After Amputation

Patients with a burn-related amputation can experience physical and emotional changes and challenges. Most will participate in a rehabilitation program and adjust to a new lifestyle.

Physical Outcomes

Range of Motion

Range of motion refers to how much a joint can move. Scarring can limit a patient’s range of motion. Burn patients have a high risk of developing the following:

• Hypertrophic scarring (thick, deep scars in the skin)
• Contractures (thick, deep scars that cross over joints)

Engaging in range-of-motion exercises and rehabilitation therapy soon after amputation may decrease the effects of scarring. Having good range of motion helps patients with activities of daily living (getting dressed, brushing your teeth, etc.), functional activities, recovery, and potentially using a prosthesis in the future.

Feeling and Sensitivity of Skin

The injured skin around an amputation site may

• Be extra sensitive to touch (e.g., the feeling of different fabrics) or to hot and cold temperatures
• Have decreased or increased sensitivity, which can increase the chance of skin breakdown over time

Burn injury over muscles and tendons may heal slowly and require grafting or plastic surgery, which can delay prosthetic fitting and rehabilitation. Three parts of early rehabilitation will help to prepare the skin and the rest of the limb for the prosthesis:

• Using compression wraps or bandages to manage edema (swelling) and help shape the residual limb
• Stretching to maintain or increase the range of motion and reduce muscle and scar tightness
• Doing range-of-motion exercises, which are important to support functional use of the extremity with or without a prosthesis

Pain and Pain Management

Three types of pain are common among burn survivors who have sustained an amputation:

• Residual limb pain (RLP). RLP is pain at the amputation site and in areas of the remaining limb. RLP is common during the first few weeks after amputation. This type of pain tends to decrease as the remaining limb heals.
• Phantom limb sensation (PLS). With PLS, patients think they feel sensations—such as tingling or itching— in the part of the limb or digit that is no longer there.
• Phantom limb pain (PLP). PLP is a sharp, shooting, or burning pain. The level of pain varies, and it tends to go away over time. PLP is common after amputation and does not prohibit success with a prosthesis.

The health care team should prescribe an individualized program to manage pain from the burn injury and pain associated with an amputation. The team should monitor or adjust pain management programs during the prosthetic fitting process. These programs can include oral or topical medications (medications that go on the skin), emotional and rehabilitation therapy, mirror therapy, and prosthetic adjustment. Pain from the burn or amputation may still occur years after amputation. Patients should consult with their medical team to explore ways to manage pain symptoms. The Managing Pain After Burn Injury factsheet contains more details about managing pain.

Pruritus

Itchy skin, or “pruritus,” is a common and normal side effect of a healing burn injury. Itching may interfere with a patient’s daily activities and overall health but should decrease over time. The Itchy Skin After Burn Injury factsheet gives a detailed overview of possible treatments and therapies to help with itchy skin.

Emotional Impact

Amputation after a burn injury is a life-changing event, and those who experience amputation may go through emotional changes and distress. Many have reported becoming less social and disliking their body image. Patients may also feel sad, angry, or anxious, or experience a loss of independence. Early support from family members, friends, and the health care team should focus on protecting and improving the survivor’s mental health.

Peer support has been shown to be tremendously valuable in the recovery of burn survivors who experience amputation. There are many local and national burn and amputee peer support groups that offer in-person or virtual support. The linked resources below offer more details on mental distress after a burn injury and accessing peer support:

• Psychological Distress After Burn Injury
• Post-Traumatic Stress Disorder (PTSD)
• Understanding and Improving Body Image After Burn Injury
• Burn Peer Support: Phoenix Society for Burn Survivors
• Support Groups and Peer Support: Amputee Coalition

Rehabilitation

Physical and/or Occupational Therapy

The goals of physical and occupational therapy include pain management and increasing the range of motion and strength of burn survivors, all with the goal of maximizing a return to independence and activities of daily living after a burn injury. Activities of daily living include tasks such as brushing your teeth, getting dressed, showering, getting in and out of bed, etc. Therapists will also help survivors learn to become independent in putting on, using, and taking off their prosthetic.

Prosthesis

The need for a prosthesis varies by type of amputation, desired use (e.g., cosmetic), and functional need. Survivors tend to be fitted for a prosthesis 1–6 months after amputation and should seek a referral from their health care team to begin the prosthetic fitting and rehabilitation process. However, there is no set timeline for a prosthetic, and patients may get fitted for one later. The Amputee Coalition offers more information about prostheses.

Exercise

Exercise—beginning as early as possible after amputation—is crucial for overall health and well-being. However, survivors may not view or participate in exercise in the same way as they did before their injury. Survivors should speak with their health care team to develop an exercise plan that fits their needs. There are many adaptations that can be made to continue activities enjoyed prior to the injury.

Life After Amputation

Many burn survivors who experience amputation lead healthy and fulfilling lives. They regain their independence and adapt to doing the activities they love, perhaps just in a different way. Remember, recovering from a burn injury can take time, and everyone progresses at their own pace. Survivors can work with their health care team to develop achievable goals and functional milestones for their recovery process. Living and thriving with a burn injury is possible!

Additional Resource

The Phoenix Society for Burn Survivors is the leading national nonprofit organization dedicated to empowering people affected by burn injury. It serves burn survivors, loved ones, burn care professionals, researchers, and anyone else committed to supporting the burn community and building a safer world. The organization provides in-person and online peer support, on-demand resources that are available 24/7, connections to a network of support organizations, and so much more. For more information, visit https://www.phoenix-society.org.

References

Bartley, C. N., Atwell, K., Purcell, L., Cairns, B., & Charles, A. (2019). Amputation following burn injury. Journal of Burn Care & Research, 40(4), 430–436. https://doi.org/10.1093/jbcr/irz034

Fergason, J. R., & Blanck, R. (2011). Prosthetic management of the burn amputation. Physical Medicine and Rehabilitation Clinics of North America, 22(2), 277–299, vi. https://doi.org/10.1016/j.pmr.2011.03.001

Kennedy, P. J., Young, W. M., Deva, A. K., & Haertsch, P. A. (2006). Burns and amputations: A 24-year experience. Journal of Burn Care & Research, 27(2), 183–188. https://doi.org/10.1097/01.bcr.0000203492.89591.a1

Modest, J. M., Raducha, J. E., Testa, E. J., & Eberson, C. P. (2020). Management of post-amputation pain. Rhode Island Medical Journal, 103(4), 19–22. http://www.rimed.org/rimedicaljournal/2020/05/2020-05-19-pain-modest.pdf

Şimsek, N., Öztürk, G. K., & Nahya, Z. N. (2020). The mental health of individuals with post-traumatic lower limb amputation: A qualitative study. Journal of Patient Experience, 7(6), 1665–1670. https://doi.org/10.1177/2374373520932451

Authorship

Amputation After Burn Injury was developed by Lauren Shepler, MPH; David Crandell, MD; Laura Gosselin, OT; Megan Tinney, PT, DPT; Karen Kowalske, MD; and Jeffrey Schneider, MD, in collaboration with the Model Systems Knowledge Translation Center (MSKTC).

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Burn Model System (BMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the Phoenix Society for Burn Survivors. The content of the factsheet has also been reviewed by individuals with burn injury and/or their family members.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this factsheet were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPKT0009, 90DPBU0001, 90DPBU0008). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended citation: Shepler, L., Crandell, D., Gosselin, L., Tinney, M., Kowalske, K., & Schneider, J. (2025). Amputation after burn injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/burn/factsheets/amputation-after-burn-injury

Copyright © 2025 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.