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Neuro > 5.1- Amputation 1 > Flashcards

5.1- Amputation 1 Flashcards

1
Q

How many amputees in the US? How many are new annually?

A

1.5 million w/ 120,000 new annually

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2
Q

What percentage of amputees are LE?

A

90% LE

10% UE (tend to be seen by OT)

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3
Q

What causes 75% of LE amputations? 20%?

A

75% due to peripheral vascular disease

20% trauma

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4
Q

Vascular disease (often due to diabetes) can result in amputation from ____ or ___ due to poor blood supply

A

gangrene or chronic nonhealing ulcers

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5
Q

Infection of ____ and ____ are often involved

A

skin (cellulites) and bone (osteomyelitis)

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6
Q

Dysvascular amputation (70%) is becoming more common. What are 6 risk factors?

A
  1. Diabetes- increases risk 4x
  2. Age- risk increases with age
  3. Sex- men>women
  4. Race- African American 2-4x risk
  5. MI or stroke- probably due to vascular problems
  6. Aortic Aneurism- most die, but if they do survive the tourniquets used on the LE’s when trying to save the client may be left on too long to save the leg
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7
Q

Trauma (20%) is becoming less common due to better medical care. What are 2 risk factors?

A
  1. MVA’s- car and motorcycle

2. Industrial accidents- machines, electrocutions, chemical burns

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8
Q

Other than dysvascular and trauma amputations, what are some other causes of amputations?

A
  1. Frostbite- seen with homeless population
  2. Malignancy (Osteomyelitis)- most common cause of amputation in 10-20 year olds
  3. Congenital Malformation- may be due to use of FALIDIMIDE- pregnancy anti-nausea drug used mainly in Europe
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9
Q

What European-used drug may cause congenital malformation?

A

Falidimide

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10
Q

2 types of amputations are BK and AK. These amputations are also known as _____ and ____.

A

BK or Transtibial- most common

AK or Transfemoral

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11
Q

With a BK, the _______ is left long as it has good blood supply and can be folded over the bone.

A

posterior flap of the gastroc

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12
Q

Why is the gastroc folded over the bone and sutured across the anterior portion of the shin with a BK amputee?

A

so person will not bear weight on the incision

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13
Q

With a BK, what is done with the tibia and fibula?

A

Tibia is beveled so it won’t puncture the tissue when weightbearing.

Fibula is cut 1” shorter so it will be non-weightbearing.

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14
Q

How is an AK cut?

A

Cut equally across

Femur is beveled so it won’t puncture tissue when WB

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15
Q

What does a surgeon do with blood vessels?

A

Large blood vessels are tied off and small cauterized

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16
Q

Why do nerves require special attention?

A

b/c they will form a neuroma at the end where cut off

  • surgeon pulls nerve down, cuts, and then releases so it retracts back up into the tissue where they hopefully will not WB on it
  • if the neuroma forms in the area of the prosthesis, surgery is required
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17
Q

What does a surgeon do with an amputee’s muscle at the cut?

A

generally attach them to muscle, tendons, fascia, or bone

  • cut and anchored with slight tension so it does not retract up into the limb
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18
Q

What is myoplasty?

A

most frequent closure where the muscle is attached to fascia

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19
Q

What is myodesis?

A

muscle is attached to bone or periosteum

- not done often b/c periosteum often grows bone spurs in the area- interferes with WB

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20
Q

What is tenodesis?

A

muscle is attached to tendons

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21
Q

What are the 7 levels of LE amputation?

A
  1. Toes
  2. Mid metatarsal
  3. Lisfranc
  4. Chopart
  5. Symes
  6. BK
  7. AK
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22
Q

Usually no deficits, some gait difficulty if great toe is taken

A

Toes Amputation

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23
Q

No prosthesis or gait training required

A

Mid-metatarsal amputation

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24
Q

Just distal to the talus; not generally done b/c stump is very large making it difficult to do a prosthetic- also foot is pulled into PF making ambulation impossible

A

Chopart

25
Q

Through joint superior to proximal met heads; no longer done

A

Lisfranc

  • no longer done b/c of nasty contractures
  • gastroc shortens=nasty contracture
26
Q

Disarticulation at the ankle- talus and foot are removed, but heel fat pad is left to cushion the stump

A

Symes

  • not used often, but occasionally
  • difficult prosthesis due to shape of limb
27
Q

A BK amputation needs to try to have ____ left below the knee.

A

6-8”

28
Q

Why are short stumps difficult? (BK)

A

there is too short of a lever arm in the prosthesis- not enough leverage

29
Q

Why are too long stumps difficult? (BK)

A

there is not enough muscle bulk left to cover the bone; also can’t use an ankle in the prosthesis

30
Q

With an AK amputation, plenty of muscle is left but what is generally left only allows ____ and ____.

A

hip extension and abduction (adductors generally cut)

31
Q

What are the advantages of knee disarticulation? Disadvantages?

A

Advantages- good for WB; athletes tend to like b/c of easy and quick recovery after

Disadvantages- b/c of the design of the prosthesis the knee will stick out when sitting; rarely done with women due to cosmesis

32
Q

What are 8 AK amputations?

A
  1. Knee disarticulation
  2. Supracondylar
  3. Long AK
  4. Short AK
  5. Medium AK
  6. Hip disarticulation
  7. Hemipelvectomy
  8. Carparectomy
33
Q

Why is a supracondylar amputation very rare?

A
  • problems with space for the artificial knee

- used when very unstable knee in elderly client

34
Q

What AK amputation is most optimal?

A

Medium AK- 10” residual limb

35
Q

Why is a short AK difficult to use?

A

short lever arm, not enough leverage in prosthetic

36
Q

Hip disarticulation is very rare. So why would a hemipelvectomy be done?

A

part of pelvis is removed due to malignancy- no prosthetic

37
Q

A carparectomy is a bilateral hemipelvectomy. Where is the cut?

A

Cut at L5 level (real severe cancer situation)

  • no prosthetic
  • need to reroute bowel and bladder
38
Q

What is #1 post-op rehab goal?

A

control edema

  • lots of swelling which inhibits normal blood flow
  • causes pain and slow healing
  • can’t fit prosthetic until edema is down and residual limb appropriate shape
39
Q

What are post-op options, depending on the surgeon?

A
  1. Rigid cast
  2. Intermediate Postoperative Prosthetic (IPOP)
  3. Removal rigid cast
  4. Soft dressing- Ace wrap or Shrinker
40
Q
  • Applied to limb in recovery or after sutures are removed to reduce edema and shape the stump
  • Suspension with a waist belt
  • Change every 3-10 days
A

Rigid cast

41
Q

What are some negatives with the rigid cast?

A
  • good job with edema and shaping, but CAN’T INSPECT WOUND

- not appropriate for pt. w/ poor circulation

42
Q
  • Rigid dressing with pylon attached- foot attached for immediate WB
  • Used with young patients w/ good skin/balance
A

Intermediate Postoperative Prosthetic (IPOP)

43
Q

What is an advantage for the IPOP? Disadvantage?

A

Advantage- early WB (20# force) decreases edema and gives psychological boost

Disadvantage- can’t inspect wound; not appropriate for pt. w/ poor circulation

44
Q
  • Applied after sutures are removed
  • Usually traumatic amputee
  • Made of plaster shell, socks (plys changed as limb volume decreases), and plastic cuff closed by Velcro
A

Removal rigid cast

not applied right away like rigid cast or IPOP

45
Q

What are some advantages for removal rigid cast?

A
  • removed to inspect skin

- can WB on bed or chair, but not ambulate

46
Q

An Ace wrap is not as good with edema but cheap, easy to change, and you can teach client how to wrap. What kind of Ace wrap should be used?

A

4” Ace bandage for BK

2- 6” sewn together end to end for AK

47
Q

How is the Ace bandage applied?

A
  • Figure 8 pattern used with more pressure distal than proximal
  • Forces swelling out and shapes stump to a cone shape that fits prosthesis
48
Q

How often should you teach patient to rewrap with an Ace bandage?

A

every 3 hours- allows blood flow and bandage loosens over time- also allows skin inspection

49
Q

What happens if the Ace bandage is applied incorrectly?

A

can create tourniquet effect and cause bulbous limb

50
Q

What is a Shrinker?

A
  • works same way as Ace, but is easier to do on own
  • must be replaced often as limb shrinks
  • can use Ace and shrinker together- helps hold Ace in place
51
Q

How long is some form of compression used?

A

constantly for 1 year- only taken off to bathe or wear prosthesis

52
Q

One rehab goal is to control edema. Another rehab goal is to prevent contractures. Where are the worst contractures?

A
  • often have even before amputation
  • knee and hip are common due to laying in bed with pillow under the knee
  • joint closest to the amputation will have worst contracture
53
Q

How does PT/PTA prevent contractures?

A
  • don’t hang stump over the bed when in supine
  • don’t put pillow under the knee
  • don’t sit with legs crossed (increases vascular problems)
  • GET INTO PRONE POSITION ASAP
54
Q

A PT/PTA needs to help maintain and increase strength in the affected LE. How?

A
  • need abduction and extension to help with ambulation (esp AK- to pull limb thru gait swing)
  • manual resistance and mat exercises
  • quadraped to tall kneeling exercises- WB through limb and core stabilization
55
Q

Rehab goals include controlling edema, preventing contractures, and maintaining and increasing strength in the affected LE. We also want to help regain independence with mobility and self care. How?

A

Work on bed mobility, transfers, ambulation with walker w/o prosthesis- gives idea about motivation and ability

  • prosthetics are very expensive, so they won’t give one to someone who won’t use it
56
Q

There is a very high energy expenditure with prosthetic so work on _______.

A

muscular and cardiovascular endurance

57
Q

Why does the patient need to learn care of opposite extremity (sound leg)?

A
  • already compromised- don’t want to loose other leg
  • will have more stress on good leg now
  • need good footwear to avoid pressure problems
58
Q

A PT/PTA rehab goal should assist patient with adjustment to loss of a body part. We should also teach skin care. What should we teach about skin care?

A
  • inspection and proper cleaning
  • scar massage, especially on tibia with BK is necessary so it does not adhere to the bone
  • desensitization (nerve ending will be very angry!)

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