1: Introduction to Amputations Flashcards
What is the definition of an amputation?
Surgical removal of a body part (partial or full) due to disease, trauma, or injury
What is a prosthesis?
Replacement of all or part of the extremity removed
Are men or women more likely to have an amputation?
Men (65%)
50% of people who have an amputation due to vascular disease will die within how many years?
5 years
55% of people who have an amputation due to diabetes will have a second amputation within how long?
2-3 years
Which is more likely to be amputated? LE or UE?
LE is 11x more likely to require an amputation
What are the three health-related risk factors for amputation?
Diabetes, hypertension, dyslipidemia
What is the leading cause of LE non-traumatic amputations?
Diabetes
What is the second leading cause of amputation?
Trauma - young adults, machinery, power tools, appliances, firearms, MVA
What is the third leading cause of amputation?
Cancer - primary or secondary due to metastatic disease
What are examples of non-traumatic amputation?
PVD, diabetes, limb deficiencies, congenital, infection, tumor, disease
What are common causes of amputation in children?
Congenital limb deformities, tumors, trauma, infection
What is limb preservation?
Surgical procedure involving re-vascularization, bone grafting, flag coverage, repair of nerves, compartment syndrome, skeletal stabilization
What three factors determine the level of an amputation?
- Ability to heal successfully at the incision based on adequate circulation
- Removal of all non-viable tissues, structures, especially in the presence of infection
- Achieve long term functional residual limb, restore to some level of activity without pain
What are the goals of surgically amputating an limb?
Maintain the most adequate length of the residual limb, protest neurovasculature, muscle stabilization, scar and skin, functional shape of residual limb
How are neuromas prevented during surgical amputation?
Major nerves are cut high and retract into the soft tissue
What is ligation?
Type or closing off of major arteries and veins, cauterization of smaller vessels
What side of the body with the skin flap originate from and why?
Posterior because the tissue typically has a better blood supply
Define myofascial
Surgically connecting muscle to skin
Define myoplasty
Surgically connecting muscle to muscle
Define myodesis
Surgically connecting muscle to bone
Define tenodesis
Surgically connecting tendon to bone
What are the 8 common complications following amputation?
Neuroma, psychological impact, wound infection, contracture, DVT, phantom limb, phantom pain, hypersensitivity
What is a neuroma?
Bundle of nerve endings that group together and can produce pain due to scar tissue and pressure from the prosthesis
What is the psychological impact of amputation?
Denial, grief, anxiety, depression, suicidal ideation
Why can contractures develop after amputation?
Failure to initiate full ROM early in post-op phase and poor positioning
Describe phantom limb
Painless sensation where the pt feels that their limb is still present. Commonly occurs immediately after amputation and subsides with desensitization and prosthetic use
Describe phantom pain
Perception of pain stimulus distal to amputation level
Why is decreasing hypersensitivity following amputation important
Can impede or prevent fit and functional use of prosthesis
What three factors increase the risk of re-amputation?
Previous amputation, level of amputation, comorbidities
What are 6 common causes of amputation?
- Diabetes
- PVD
- Tumor
- Infection
- Burns
- Trauma
What are three complications of diabetes that can lead to amputation?
Macrovascular problems, microvascular problems, neurological problems
What are the four principles related to amputation in children?
- Preserve the proximal joints - hip and knee
- Preserve length and growth plates
- Amputate through the joint if the distal bone cannot be salvaged
- Proximal osteotomies or external fixation techniques may be needed to accommodate growth
What is the level of the amputation dependent on?
Vasculature status of the limb, neuropathy, infection, necrosis, malignancy, bone and joint condition, age, function, rehab potential
What is preserved with a Lisfranc amputation?
Both dorsiflexors and plantarflexors
What is preserved and sacrificed with a transverse tarsal amputation?
Plantarflexors are preserved and the dorsiflexors are sacrificed
What is the location of a Symes amputation?
Removal of the foot and ankle with the removal of the malleoli
Describe the K0 classification level
Prosthesis will not enhance the QOL or mobility. Pt is not eligible for prosthesis for knee or foot unit
Describe the K1 classification level
Transfers, ambulate on level surfaces, fixed cadence. Limited or unlimited household ambulator
Describe the K2 classification level
Transfers low-level barriers, curbs, stairs, uneven surfaces. Limited community ambulator
Describe the K3 classification level
Variable cadence ambulator, transverse most environmental barriers, prosthetic use beyond simple locomotion. Unlimited community ambulator
Describe the K4 classification level
Exceeds basic ambulation skills, high impact, stress, or energy levels. Typical of child, athlete, or active adult
What is the L Test and what is the basic procedure?
Functional mobility measure adapted from the TUG. Pt is in a chair, walks 3 m, turns 90 degrees, walks 7 m, then goes back
What are the measures of the L Test?
Time and quality of gait pattern
What is the MCID of the L Test?
4.5 seconds
What is the AMP Test assess?
Variation of transfers, mobility, balance, gait, and stair assessment
What is the AMP Test score associated with?
Directly related to K levels
What is the MDC for the AMP for unilateral lower limb amputation?
3.4 points
What does the PEQ assess?
VAS scale to evaluate the prosthesis and life
What are the categories on the PEQ?
Satisfaction, well-being, frustration, pain, residual limb health
What is the OPUS and what does it assess?
Simple survey assessing functional status, QOL, satisfaction
What is the TAPES-R and what does it assess?
Multi-dimensional tool that assessed activity restriction, psychosocial adjustment, satisfaction with prosthesis, and factors influencing health
