Amputation Management and Rehab

Question 1

• one of every ____ americans will have an amputation
• ___ as common in ment
• over 80% due to ________ and _______
• over 70% of UE are due to _____

Answer 1

• 200
• twice
• vascular disease, neuropathy
• trauma

Question 2

most diabetic amputations are preceeded by ____

Answer 2

foot ulcer

Question 3

• over half those whose PVD results in amputation will eventually undergo ________
• 30 dat mortality
• 5 year mortality

Answer 3

• bilateral amputations
• 40%
• 70%

Question 4

Salvage vs. Amputation

• higher lifetime cost?
• increased risk of subsequent hospitalization
• better fxnl outcomes
• more psychologically acceptible

Answer 4

• amp
• salvage
• amp
• salvage

Question 5

amputation secondary to malignancy is most commonly where?

Answer 5

lower limbs

Question 6

in pediatric amputation, 60% are ____ and 40% are ______

Answer 6

congenital, acquired

Question 7

-______ often present with comorbidities, neuropathy, vascular compromise, infection, or osteomyelitis

Answer 7

dysvascular patients

Question 8

-_____ often involve open, comminuted fractures with soft tissue loss and vascular/nerve disruption

Answer 8

traumatic injuries

Question 9

-_______ is indicated in high grade neoplasms, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease

Answer 9

cancer-related amputation

Question 10

skin and muscle are divided into _________.

Answer 10

anterior and posterior flaps (which are sewn together to form residual limb after vessels and nerves are severed and bone is severed and filled)

Question 11

myodesis closure technique

Answer 11

transected muscles are re-attached by suturing through drill holes at distal end of the bone

Question 12

tenodesis closure technique

Answer 12

intact tendons reattached to bone

Question 13

myofascial closure technique

Answer 13

fascial envelope is sutured over transected muscles

Question 14

myoplasty closure technique

Answer 14

suturing of one muscle group to its antagonist

Question 15

open (guillotine), provisional or delayed closure

Answer 15

indicated if severe infection or toxicity are present

Question 16

osteomyoplasty (Ertl Procedure)

Answer 16

osteoperiosteal flap is harvested from amputated tibia and implanted, bridging distal tibia and fibular ends. incision is closed over bone bridge

Question 17

what is the purpose of osteomyoplast (ertl procedure)

Answer 17

stabilizes distal tibia and femur

• prevents “chopsticking” of distal bone ends
• improves weight bearing on residual limb

Question 18

name some post-operative complications

Answer 18

contracture, edema, phantom limb sensation or pain, personal grief and depression
Sx complications

Question 19

Post-surgical phase goals

Answer 19

compression, ROM, Positioning, endurance

Question 20

when does the post-surgical phase end?

Answer 20

when patient is provided with a definitive prosthesis

Question 21

Rigid post-op dressing (IPOP)

Answer 21

immediate post-op prosthesis

-plaster socket with removable pylon and foot

Question 22

IPOP advantages

Answer 22

limits edema, reduces pain, prevents contracture, protects limb, allows early WBing and gait, easier to move to definitive prosthesis

Question 23

IPOP disadvantages

Answer 23

difficult to apply, requires very close supervision, cannot visualize wound or residual limb

Question 24

Rigid removable post-op dressing (RRD)

Answer 24

after suture/staple is removed, a polypropylene or cast is fit from an impression of the residual limb
- the rrd is worn OVER wound dressing or compression socks

Question 25

RRD advantages

Answer 25

allows skin inspection, provides consistent pressure, easily donned, protects residual limb

Question 26

RRD disadvantages

Answer 26

may require frequent refitting

Question 27

Semi-rigid post-op dressing

Answer 27

zinc-oxide, gelatin, gylcerin, and calamine compound | Applied in OR or PACU

Question 28

Semi-rigid post-op dressing advantages

Answer 28

controls edema, adheres to skin, allows some ROM, breathable, inexpensive, easy to contour

Question 29

semi-rigid post-op dressing disadvantages

Answer 29

loses effectiveness as edema resolves, not as protective, may permit contracture formation

Question 30

Soft dressing

Answer 30

incision dressed with 4x4s and kerlix | compression provided with ACE bandages or elastic shrinker

Question 31

soft dressing advantages

Answer 31

inexpensive, lightweight, readily available

Question 32

soft dressing disadvantages

Answer 32

inconsistent, weak compression, requires frequent re-wrapping and replacement, does not prevent contracture, difficult for patient to self-apply

Question 33

ACE wrapping - every _____ - ___ to ___ pressure gradient - below knee - above knee - pattern

Answer 33

- 4-6 hours - distal to proximal - pull M to L, P to A direction - include adductor tissue and pull into ext and add - figure 8

Question 34

Limb shrinkers - what are they? - gradient - AKA socks require ____ - size determined by _______ - wear _____ - continue _____

Answer 34

- elastic socks that help decrease edema and assist in shaping the residual limb - distal to proximal - circumference and length - 24 hrs/day - skin inspection

Question 35

limb socks - used for - absorbs ___ - fabric - ply

Answer 35

- between residual limb and prosthetic socket for protection, friction absorption, and to fill socket volume - perspiration - cotton, wool, or blend - 1, 3, 5, up to 15

Question 36

what is phantom limb sensation? | -prevalence

Answer 36

painless awarness of the amputated body part, often mild tingling - occurs in 90% of traumatic and surgical amputees - usually persists throughout life, normal

Question 37

phantom limb pain

Answer 37

can be constant or intermittent, 30-75% of amputees (usually after crush injury or in later life, not congenital)

Question 38

phantom limb pain interventions

Answer 38

desensitization, massage, compression, exercise, limb handling and use, TENS, US, icing, psych counseling, mirror therapy

Question 39

- scar maturation occurs for up to ____ | - skin integrity and pressure tolerance only ____ of normal

Answer 39

- one year | - 40%

Question 40

Positioning - initiate ROM when? - initiate positioning when?

Answer 40

- usually immediately post-op | - as soon as medically feasible

Question 41

ther ex - maintain full ROM and strengthen ______ - ___ chain - what happens to energy cost?

Answer 41

- hip adductors, extensors, and knee extensors - closed - increased energy cost

Question 42

- transfer training should begin ____ - what transfer? - position of RW

Answer 42

- POD 1 if possible - stand pivot with RW - with elbows in full extension

Question 43

- w/c and cushion for those at high risk for ________ | - need ______

Answer 43

- skin compromise or socket intolerance | - anti-tip system

Question 44

What are the best predictors of prosthetic potential?

Answer 44

level of amputation and pre-surgical function

Question 45

-any _____ and ____can be functionally independent

Answer 45

unilateral BKA or younger bilateral BKA amputee

Question 46

- older unilateral AKA and most bilateral AKA amputees ____________

Answer 46

will have difficulty regaining upright independence

Question 47

name some residual limb requirements for prosthetic use

Answer 47

fully healed incision, no s/s of infection, no drainage from incision site, ability to tolerate weight bearing, frequent skin inspection

Question 48

when to refer to a prosthetist

Answer 48

if weight gain, volume change, ROM or functional changes affect fit

Question 49

UE amputation - utilize ______ - ____ is often an issue, esp. in peds

Answer 49

- harness and body-powered cable control systems | - acceptance