Amputation Basics

Question 1

What are the most common causes of amputation?

Answer 1

1. PVD
2. Trauma
3. Tumors

Question 2

Symes Disarticulation

Answer 2

Ankle Disarticulation
Heel pad is attached to the distal tibia for functional WB
Not cosmetically favored

Question 3

Levels of TT amputation

Answer 3

Long - >50% tibial length
Standard - 20-50% tibial length
Preferred level is at taper
 of gastrocnemius
Short - <20% tibial length

Question 4

Levels of TF amputation

Answer 4

Long - >60% femoral length
Standard - 35-60% femoral length
Short - <35% femoral length

Question 5

Van Ness Rotationplasty

Answer 5

Ankle Joint becomes functional knee joint
Essentially remove above and below knee and reattach tibia onto femur
Can run and jump with prosthesis

Question 6

Ideal Post-op scar

Answer 6

Pliable
Painless
Nonadherent

Question 7

Types of Surgical Closures

Answer 7

Equal length posterior and anterior flaps - Scar is at bottom of the residual limb
For well-vascularized patients
Long posterior flap - Scar is anterior
For compromised circulation – why? easier to see?
Skew flap - Scar is angular medial-lateral
Places scar away from bony prominences
Also for compromised circulation

Question 8

Stabilization Methods of Muscle

Answer 8

Myofascial closure - Attach muscle to fascia
Myoplasty - Muscle to other muscle
Myodesis - Muscle to bone
Tenodesis - Tendon to bone

Question 9

Neuromas

Answer 9

Severed nerves form a collection of nerve ends
Must be surrounded by soft tissue
If they form close to scar tissue or bone cause pain
Interfere with prosthetic wear

Question 10

Describe the ideal residual limb

Answer 10

No excessive redundant tissue
Incision is not under tension
Circulation is good to all distal tissues, especially the skin flaps
Bone ends are smoothed and rounded
Distal tibia is beveled
Save as much bone length as possible

Question 11

What slows or prevents healing of an amputation?

Answer 11

Infection
Smoking
Severity of vascular problems
Diabetes 
Renal dysfunction
Heart disease

What can a PT do to facilitate wound healing? Promote mobility

Question 12

Types of post-surgical Dressings: Elastic Bandage

Answer 12

Ace wrap (10-14 days)
Adv: Easy to apply
Inexpensive
Easy access to incision
DisAdv: Little edema control
Minimal RL protection
Requires frequent  
  Rewrapping (every 2 hours)

Question 13

Types of post-surgical Dressings: Shrinker

Answer 13

From suture removal through rest of life
Adv: Easy to apply
Inexpensive
Easy access to incision
Can be applied by 
  patient
Disadv:Little edema control
Requires changing as RL 
  shrinks
Not used until sutures 
  are removed?

Question 14

Types of post-surgical Dressings: Semirigid Dressing

Answer 14

Unna’s dressing or air splint
Adv: etter edema control 
  than soft dressings
RL protection
Disadv: Needs frequent changing
Cannot be applied by 
  patient
No access to incision

Question 15

Types of post-surgical Dressings: IPOP or EPOP

Answer 15

Immediate/Early Postsurgical Prosthesis
Adv: Excellent edema control
Excellent RL protection
Control of RL pain
Disadv: No access to incision
Most expensive
Requires proper training 
  for use
Not adjustable  or 
  removable

Question 16

Weight Tolerant areas in the transtibial limb

Answer 16

1. Patellar Tendon
2. Medial tibial flare
3. Pre-tibial Muscles
4. Posterior distal aspect of the limb
5. Popliteal fossa
6. Fibular shaft
7. Hydrostatic