The Health Department has approved an algorithm for routing patients to Competence Centers for Limb Amputations.

The patient routing algorithm to Competence Centers consists of three stages: inpatient care, rehabilitation in a specialized facility, and rehabilitation at home.

Patient transportation will be handled by the A.S. Puchkov Emergency and Urgent Medical Care Station. If hospitalization occurs as an emergency at the nearest medical facility, after life-threatening conditions have been controlled, the patient will be transferred to one of the medical centers approved by this order. If the patient is in critical condition, sanitizing amputations may be performed at the initial hospitalization site, followed by transfer to a specialized center for continued treatment and re-amputation.

To assess the potential for prosthetic replacement, an initial medical commission consisting of a surgeon, a traumatologist-orthopedist, a physical and rehabilitation physician, a methodologist, and other specialists (if necessary) will be convened within two to three days after the amputation. The commission will determine the need for further examination and issue a referral to the Main Bureau of Medical and Social Expertise, specifying the type of prosthesis and technical rehabilitation aids required for the development of an individualized rehabilitation plan.

The second consultation will be held two to three days before the planned discharge date. The consultation will determine the patient's suitability for prosthetics and determine whether there are indications for referral to the S.I. Spasokukotsky Moscow Scientific and Practical Center for Medical Rehabilitation, Restorative, and Sports Medicine. The patient's condition will be assessed using the following scales: the Rehabilitation Routing Scale, the Barthel Index, the Muscle Strength Rating Scale (MRCS), the Visual Analogue Pain Scale, and goniometry.

A series of rehabilitation measures will be carried out at the above-mentioned facility for 14 days. A single medical examination will be held on days 10–14 to re-evaluate the patient's prospects for prosthetic replacement. If the assessment confirms a positive prosthetic replacement prospects, the scope of outpatient rehabilitation measures will be determined.

The third stage of the routing process is aimed at comprehensive rehabilitation at home. Within three working days of the patient's discharge from the rehabilitation facility, an on-site interdepartmental consultation is held to develop an individualized comprehensive rehabilitation plan and dynamically monitor the stump's development at home. Comprehensive rehabilitation may include, among other things, exercise therapy, massage, physical therapy, social and psychological , social and environmental rehabilitation. The rehabilitation period and preparation for prosthetic fitting lasts from 30 to 62 days.

Indications for referring the patient to the multidisciplinary hospital where the amputation was performed for specialized (corrective) surgical treatment include neuromas requiring radiofrequency ablation or other treatment methods, stump eschars, wound edge divergence, ligature fistulas requiring secondary surgical treatment, osteophytes, stumps requiring scar/soft tissue grafting or reamputation, and active purulent processes.

Contraindications for primary prosthetics and rehabilitation include somatic diseases in the acute/subacute phase, cachexia of any origin, infectious diseases in acute or contagious form, malignant oncological diseases of I, II and IV clinical groups of dispensary observation, neurological diseases with significantly pronounced disorders of statics and coordination of movements, dysfunction of the human body, contractures of adjacent joints that make stumps unsuitable for the use of a prosthesis, patient's refusal of exoprosthetics.

The list also includes mental disorders leading to a significant reduction or absence of critical assessment of one's condition and situation, behavioral disorders, affective-volitional disorders, psychopathic-like disorders, and psychopathic personality disorder (alcoholism and drug addiction). The 10-item list also states that primary prosthetics and medical rehabilitation will not be available to foreign and non-resident citizens, as well as individuals without Moscow registration.

The list of Competence Centers for Limb Amputation consists of seven medical institutions. These include the M.P. Konchalovsky City Clinical Hospital, the S.S. Yudin City Clinical Hospital, the O.M. Filatov City Clinical Hospital No. 15, the A.K. Yeramishantsev City Clinical Hospital, the L.A. Vorokhobov City Clinical Hospital No. 67, the V.P. Demikhov City Clinical Hospital, and the Kommunarka Moscow Multidisciplinary Clinical Center.

In May 2024, the head of the Moscow Department of Health, Alexey Khripun, signed an order requiring that competence centers for reconstructive and plastic reamputations be established at City Clinical Hospital No. 31 named after Academician G.M. Savelyeva, City Clinical Hospital named after V.P. Demikhov, and War Veterans' Hospital No. 3 by July 10, 2024. The Department of Health stated that the purpose of establishing these units is to organize and improve the provision of planned specialized care to patients who have undergone limb amputation.