Amputation Flashcards by PHILYP EPHRAIM PARANGALAN

what is amputation

removal of a limb or part of a limb

d/t:
- PVD
- trauma
- congenital

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exp how PVD can cause ampu

poor BF to an area = necrosis and can spread

to stop spread and rpeserve limb you ampu the necrotic tissue

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exp how trauma can cause ampu

very comminuted fx - di na ma fix c surgery so amputate n lang

poor circulation kaya ampu to prevent spread

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exp how congenital can cause ampu

born c limb defect

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what are components usually determined by surgeon

length of residual limb

vascularization prothetic

fitting

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discuss length of residual limb

based on extent of injury/infection and functional goals

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discuss vascularization prothetic

if there is enough BF for limb to survive

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discuss fitting of prosthetic

if gusto ba mag prosthesis or not

not all can afford and older baka inde na

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compare open vs closed ampu

open: chop lang; guillotine
- causes part of skin to retract = infection
- UE

closed: uses skin flaps to cover
- LE

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discuss diff skin flaps

sagittal/median

post - MC; closed flaps from post

skewed - diagonal slice and suture; flaps come from front and back

fishmouth - equal front and back then closed like fishmouth

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what is muscle stabilization

need to stab muscles after ampu to prevent retraction

when muscle gets putol nag iiba line of pull hence can affect pos of stump or contractures

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what are the different connections of muscles

myoplasty - muscle to muscle

myofascial - muscle c fascia

myodesis - muscle to bone

tenodesis - tendon to tendon

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discuss stumps

should prep stumps for prosthesis

prevent dog ears - affects function and pain

can do bandaging - figure of 8

we dont want weight on stump

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indication for conical stump

AKA

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indication for cylindrical stump

BKA

weight placed on patellar tendon

like kneeling

redness should be on pat tendon only not sa iba places

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discuss bulbous stumps

does not ensure if kasya sa prosthesis

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discuss krukenberg amputation

UE ampu - radius and ulna preserved to keep some function

not all can afford prosthesis

can be elbow or shoulder controlled - need to retrain

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discuss amelia

absence of limb

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discuss phocomelia

absence of middle part of limb then distal is attached

flipper like

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discuss meromelia

absence of upper part then distal attached

discuss aphalangia

absence of finger or toe

discuss hemimelia

absence of half a limb

discuss adactyly

absence of metacarpal or metatarsal

discuss acheira

missing hand or foot

significance of prosthesis in pedia

need to account new fittings as child grows

compare acute and chronic ampu in terms of pain

acute: painful talaga since may sugat chronic: phantom limb pain

interventions for phantom limb pain

desensitization or mirror therapy

relate amputations to older people

often forget or neglect ampu extremity do desensitization

discuss weakness in ampu

can be d/t disuse or incised na yung muscle

discuss functional assessments in ampu

consider level of function na gusto - if need prosthesis or not ask them what they do before if they want prosthesis or not

significance of smoking to ampu

slower and harder healing esp in vascular conditions

discuss VS in ampu

BP, RR, PR PR taken segmental to see if there is circulation to stump

discuss OI in ampu

stump integrity - color, shape, incision, dressing, covering prosthesis manner of arrival

discuss palpation in ampu

pulse, edema, tightness/contracture, tenderness, adhesions if tone is balanced

AKA vs BKA presentations

AKA: affected TFL, adductors and quads - flexion and abduction contracture - can be allowed if no prosthesis BKA: knee flexion contracture

discuss anthro in ampu

stump length, circumference, scar/incision length level of ampu compare leg length to normal leg - longer prosthesis causes gait dev

discuss wound assessment in ampu

post op lang no need if di post op

discuss GA in ampu

if c/s prosthesis - assess for both if non-amb no need

discuss SA in ampu

check for specific nerves

discuss ROM and MMT in ampu

of the remaining limbs and accessory muscles

discuss FA in ampu

desired functions or previous functions of pt

OMT for ampu

amputee mobility predictor barthel ADL index TUG 6MWT

diff IS in ampu

restorative - walking preventive - contractures adaptive - prosthesis

discuss pre-operative phase

should see pt before ampu joint integrity - dapat no contractures and intact ROM MMT - strengthen affected, unaffected and UE muscles for crutch walking conditioning - CV and muscle

UE muscles for AD

triceps, biceps, deltoids lats SA

discuss post-operative phase

pain management stretching and strengthening - stump pos conditioning - CV and muscle will be working harder phantom sensations - mirror or desen functional training pt educ wound care

discuss post-operative: pre-prosthetic phase

stump care - shape, clean and no dog ears CV conditioning - d/t added energy expenditure functional training - amb, stair neg, sports pt educ - wound care

discuss post-operative: prosthetic phase

prosthetic fitting - how to don and types - c or s knee/ankle jt stump care - inspect stump, redness on tendons or back of knee dapat CV condi functional training - gait train c prosthesis pt educ