Amputation Flashcards
A surgery to remove all or part of a limb or extremity
Amputation
Purpose of doing amputation
Control infections
Amputation comes from the latin word
Amputare (to cut around)
Leading cause of amputation
Peripheral Vascular Disease (PVD)
Second leading cause of amputation
Diabetes Mellitus (DM)
Other causes of amputation
HTN
Dyslipidemia
Amputation is more common in what sex?
Males
A type of amputation wherein soft tissues are closed primarily over the bony stump
Closed-type
Principles of closed amputation
Tourniquets
Level of amputation
Flaps
Muscle
Methods of muscle suture
Compression dressing
Absolute bed rest
Limb fitted
Nerves
Bones
Blood Vessels
Drains
What does a tourniquet do in a closed amputation?
Prevents excessive blood loss
When should a tourniquet be applied?
Done before actual amputation
Contraindication for tourniquet
Ischemic limb
Important to fit prosthesis
Level of amputation
Skin should be mobile and sensitive
Flaps
3 methods of muscle suture
Myodesis
Myoplasty
Tenodesis
Muscle is sutured to the bone
Myodesis
Contraindication for myodesis
Ischemic limb
Muscle to muscle closure
Myoplasty
Tendon attached to the bone
Tenodesis
What are the types of compression dressing used in amputation?
Elastic or rigid plaster dressing
Acceptable for conventional prosthesis with adequate vascularity
Absolute bed rest with limb elevation
How long is a conventional prosthesis fitted for?
A minimum of 8-12 weeks after surgery
How are nerves cut in amputation?
Cut proximally and allowed to retract
How are large nerves cut?
Large nerves are ligated before division
How are blood vessels cut in amputation?
Doubly ligated and cut
How long do drains stay for?
Removed after 48-72 hours
Two types of open amputation
Guillotine
Circular
Treatments following open amputation
Rigid dressing concept (Pylon)
Soft dressing concept
POP cast is applied to the stump over the dressing after surgery
Rigid dressing concept (Pylon)
Stump is dressed with the sterile dressing and elastocrepe bandage applied over it.
Soft dressing concept
Complications of amputation
Hematoma
Infection
Necrosis
Contracture
Neuroma
Stump pain
Phantom sensation
Hyperesthesia of stump
Stump edema
Bone overgrowth
Causalgia
The sensation in body regions where limbs or body parts used to exist
Phantom limb
Sensation felt in phantom limb
tingling
burning
itching
pressure
numbness (sometimes)
Scar over the surgical incision poses a problem in process of rehab
Painful adhesive scar formation
How can a phantom limb be addressed?
Providing proprioceptive feedback for the artificial limb
Scar over surgical incidion
Painful adhesive scar
How can painful adhesive scar be addressed?
Early mobilization of the painful scar with other therapeutic modalities
How many weeks does new bone form after electrical burn?
5 weeks
Signs found in the residual limb that may be a sign of new bone formation
Warmth
Tenderness
Swelling
What is the percentage of trauma-caused amputation?
16.4
What is the percentage of amputations caused by neuropathy and vascular conditions?
81.9
What is the percentage of cancer-related amputation?
0.9%
What is the percentage of amputations that is caused by congenital abnormalities?
0.8%
Exclusion of any of one or more toes
Partial toe
Disarticulation at the MTT joint
Toe disarticulation
Resection of 3rd, 4th, and 5th MTT and digits
Partial foot/ray resection
Amputation through the midsection of all MTT
Transmetatarsal
Ankle disarticulation c the attachment of the heel to the distal end of tibia; May include removal of malleoli and distal tibia/fibula flares
Ankle disarticulation (Syme’s)
More than 50% of the tibial length
Long transtibial (below knee)
Less than 20% of the tibial length
Transtibial (below knee)
Amputation through the knee joint; femur is intact
Knee disarticulation
More than 60% of the femoral length
Long transfemoral (above knee)
Between 35-65% of the femoral length
Transfemoral (above knee)
Less than 35% of the femoral length
Short transfemoral (above knee)
Amputation through the hip joint; pelvis intact
Hip disarticulation
Resection of the lower half of the pelvis
Hemipelvectomy
Amputation of both lower limbs and pelvis below L4-L5
Hemicorporectomy
Partial hand
Partial hand
Wrist disarticulation
Wrist disarticulation
Below elbow
Transradial
Elbow disarticulation
Elbow disarticulation
Above elbow
Transhumeral
Energy above baseline of long transtibial
10 %
Speed of long transtibial
70 m/min
O2 cost of long transtibial
0.17 mL
Energy expenditure of average transtibial
Energy: 25%
Speed: 60 m/min
O2 cost: 0.20 mL
Energy expenditure for short transtibial
Energy: 40%
Speed: 50 m/min
O2 cost: 0.20 mL
Energy expenditure for bilateral transtibial
Energy: 41%
Speed: 50 m/min
O2 cost: 0.20%
Energy expenditure for Transfemoral
Energy: 65%
Speed: 40 m/min
O2 cost: 0.28 mL
Energy expenditure for W/C
Energy: 0-8%
Speed: 70 m/min
O2 cost: 0.16 mL
3 domains assessed during pre-op
Physical
Social
Psychological
PT Education for amputees
Phantom Limb Pain
Discussion of the surgical level
Post-op prosthetic plans
Training
Reassurance
Process for adaptation
Systems assessed in physical assessment
Ms strength
Joint mobility
Respiratory function
Balance reaction
Functional ability
Vision and Hearing status
What is assessed psychologically?
Psychological of pt
Motivation
Other psychological issues
What can be found under social assessment?
Family and friends support
Living/Work environment
Proximity to stores/shops
What are the goals of a pre-operative training?
Minimize post-op complications
Lower the rehab cost
Shorten rehab duration
What are done in training programs for amputees?
Prevent thrombosis
Prevent chest complications
Relieve pressure
Improve mobility
Educate the pt
Unaffected parts do not occur distal to and in line with deficient portion
Terminal deficiencies
Complete absence (both Rad/Ul or Tob/Fib) distal to the level of loss
Transverse
Complete longitudinal absence in either pre or post axial elements
Terminal paraxial
Intermediate parts are deficient; elements proximal to and distal to deficient portion are absent
Intercalary deficiency
Segmental absence of either pre or post axial segments; intact proximal and distal
Intercalary paraxial
Presents with foreshortening of limb
Phocomelia
Where does the length measurement of a transtibial amputation start?
Starts from the medial joint line of the knee (Alternative: Tibial tub)
Where does the length measurement of a transfemoral amputation start?
Ischial tuberosity/GT