Amputation Management and Rehab Flashcards
- one of every ____ americans will have an amputation
- ___ as common in ment
- over 80% due to ________ and _______
- over 70% of UE are due to _____
- 200
- twice
- vascular disease, neuropathy
- trauma
most diabetic amputations are preceeded by ____
foot ulcer
- over half those whose PVD results in amputation will eventually undergo ________
- 30 dat mortality
- 5 year mortality
- bilateral amputations
- 40%
- 70%
Salvage vs. Amputation
- higher lifetime cost?
- increased risk of subsequent hospitalization
- better fxnl outcomes
- more psychologically acceptible
- amp
- salvage
- amp
- salvage
amputation secondary to malignancy is most commonly where?
lower limbs
in pediatric amputation, 60% are ____ and 40% are ______
congenital, acquired
-______ often present with comorbidities, neuropathy, vascular compromise, infection, or osteomyelitis
dysvascular patients
-_____ often involve open, comminuted fractures with soft tissue loss and vascular/nerve disruption
traumatic injuries
-_______ is indicated in high grade neoplasms, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease
cancer-related amputation
skin and muscle are divided into _________.
anterior and posterior flaps (which are sewn together to form residual limb after vessels and nerves are severed and bone is severed and filled)
myodesis closure technique
transected muscles are re-attached by suturing through drill holes at distal end of the bone
tenodesis closure technique
intact tendons reattached to bone
myofascial closure technique
fascial envelope is sutured over transected muscles
myoplasty closure technique
suturing of one muscle group to its antagonist
open (guillotine), provisional or delayed closure
indicated if severe infection or toxicity are present
osteomyoplasty (Ertl Procedure)
osteoperiosteal flap is harvested from amputated tibia and implanted, bridging distal tibia and fibular ends. incision is closed over bone bridge
what is the purpose of osteomyoplast (ertl procedure)
stabilizes distal tibia and femur
- prevents “chopsticking” of distal bone ends
- improves weight bearing on residual limb
name some post-operative complications
contracture, edema, phantom limb sensation or pain, personal grief and depression
Sx complications
Post-surgical phase goals
compression, ROM, Positioning, endurance
when does the post-surgical phase end?
when patient is provided with a definitive prosthesis
Rigid post-op dressing (IPOP)
immediate post-op prosthesis
-plaster socket with removable pylon and foot
IPOP advantages
limits edema, reduces pain, prevents contracture, protects limb, allows early WBing and gait, easier to move to definitive prosthesis
IPOP disadvantages
difficult to apply, requires very close supervision, cannot visualize wound or residual limb
Rigid removable post-op dressing (RRD)
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
RRD advantages
allows skin inspection, provides consistent pressure, easily donned, protects residual limb
RRD disadvantages
may require frequent refitting
Semi-rigid post-op dressing
zinc-oxide, gelatin, gylcerin, and calamine compound
Applied in OR or PACU
Semi-rigid post-op dressing advantages
controls edema, adheres to skin, allows some ROM, breathable, inexpensive, easy to contour
semi-rigid post-op dressing disadvantages
loses effectiveness as edema resolves, not as protective, may permit contracture formation
Soft dressing
incision dressed with 4x4s and kerlix
compression provided with ACE bandages or elastic shrinker
soft dressing advantages
inexpensive, lightweight, readily available
soft dressing disadvantages
inconsistent, weak compression, requires frequent re-wrapping and replacement, does not prevent contracture, difficult for patient to self-apply
ACE wrapping
- every _____
- ___ to ___ pressure gradient
- below knee
- above knee
- pattern
- 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
Limb shrinkers
- what are they?
- gradient
- AKA socks require ____
- size determined by _______
- wear _____
- continue _____
- elastic socks that help decrease edema and assist in shaping the residual limb
- distal to proximal
- circumference and length
- 24 hrs/day
- skin inspection
limb socks
- used for
- absorbs ___
- fabric
- ply
- 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
what is phantom limb sensation?
-prevalence
painless awarness of the amputated body part, often mild tingling
- occurs in 90% of traumatic and surgical amputees
- usually persists throughout life, normal
phantom limb pain
can be constant or intermittent, 30-75% of amputees (usually after crush injury or in later life, not congenital)
phantom limb pain interventions
desensitization, massage, compression, exercise, limb handling and use, TENS, US, icing, psych counseling, mirror therapy
- scar maturation occurs for up to ____
- skin integrity and pressure tolerance only ____ of normal
- one year
- 40%
Positioning
- initiate ROM when?
- initiate positioning when?
- usually immediately post-op
- as soon as medically feasible
ther ex
- maintain full ROM and strengthen ______
- ___ chain
- what happens to energy cost?
- hip adductors, extensors, and knee extensors
- closed
- increased energy cost
- transfer training should begin ____
- what transfer?
- position of RW
- POD 1 if possible
- stand pivot with RW
- with elbows in full extension
- w/c and cushion for those at high risk for ________
- need ______
- skin compromise or socket intolerance
- anti-tip system
What are the best predictors of prosthetic potential?
level of amputation and pre-surgical function
-any _____ and ____can be functionally independent
unilateral BKA or younger bilateral BKA amputee
- older unilateral AKA and most bilateral AKA amputees ____________
will have difficulty regaining upright independence
name some residual limb requirements for prosthetic use
fully healed incision, no s/s of infection, no drainage from incision site, ability to tolerate weight bearing, frequent skin inspection
when to refer to a prosthetist
if weight gain, volume change, ROM or functional changes affect fit
UE amputation
- utilize ______
- ____ is often an issue, esp. in peds
- harness and body-powered cable control systems
- acceptance
