Amputation Management and Rehabilitation Flashcards
Peripheral Vascular Disease
- Often associated with diabetes and/or smoking
- Diabetes increases the risk of intermittent claudication (cramping) by 4-5 times
Dysvascular Amputation
-Most amputations in those with diabetes are preceded by a foot ulceration
Traumatic Amputation
- Can be MVA, work/violence related, severe burns, etc.
- More common among younger men
Amputation vs. Salvage
- Lifetime cost of amputation is 3x higher
- Risk of hospitalization is greater after salvage
- Amputation may result in better fxnl outcomes
- Salvage may be more psychologically acceptable
Pediatric Amputation
- 3:2 male:female
- 60% congenital
- Disarticulation minimizes growth plate disruption
- Must consider longitudinal and circumferential growth
- Excellent circulation enhances wound healing
Syme’s Amputation
Ankle disarticulation with preservation of heel pad
Hemicorporectomy
Amputation of both LEs and pelvis below L4-L5
Forequarter amputation
Amputation of humerus, scapula, clavicle
Amputation is among the _______ medical procedures
oldest
Muscle length must be preserved to prevent:
Contracture and Atrophy
Muscle Stabilization Techniques (5)
- Myodesis
- Tenodesis
- Myofascial
- Myoplasty
- Open (guillotine)
Myodesis
Transected muscles are re-attached by suturing through drill holes at distal end of the bone
Tenodesis
Intact tendons re-attached to bone
Myofascial
Fascial envelope is sutured over transected muscles
Myoplasty
Suturing of one muscle group to its antagonist
Osteomyoplasty
- Used in transtibial amputation
- Flap is harvested from amputated tibia
- Stabilizes distal tibia and femur (prevents “chopsticking”)
Post-op Complications
- Contracture
- Edema
- Phantom limb sensation or pain
- Personal grief and depression
- Surgical complications
Goals of Acute Rehab (5)
- Prevent complications and allow healing
- Develop limb strength and ROM for prosthesis
- Maximize independence in mobility and ADLs
- Pre-prosthetic training and limb preparation
- Endurance training and initiation of HEP
Post-surgical Phase components (4)
- Compression
- ROM
- Positioning
- Endurance
Post-op Dressings (4)
- Rigid Dressing
- Rigid Removable Dressing
- Semi-Rigid Dressing
- Soft Dressing
Rigid Dressing
- Immediate Post-Op Prosthesis
- Plaster socket with removable pylon and foot
- Limits edema, reduces pain, prevents contracture, allows early weight-bearing and gait
Rigid Removable Dressing
- After suture/staple removal, a polypropylene or cast is fit from an impression of the residual limb
- The RRD is worn over the wound dressing or compression socks
- Allows skin inspection, provides consistent pressure, easily donned, protects residual limb
Semi-Rigid Dressing
- Zinc-oxide, gelatin, glycerin, and calamine compound
- Applied in OR or PACU
- Controls edema, adheres to skin, allows some ROM, breathable, inexpensive, easy to contour
Soft Dressing
- Incision dressed with 4x4’s and Kerlix
- Compression provided with ACE bandages or elastic shrinker
- Inexpensive, Lightweight, Readily available
ACE Wrapping
- Must be rewrapped every 4-6 hours
- Distal to proximal pressure gradient
- Figure-8 pattern to prevent tourniquet effect
- Medial to lateral
Limb Shrinkers
Elastic socks that help decrease edema and assist in shaping the residual limb
Limb Socks
Used b/w residual limb and prosthetic socket for protection, friction absorption and to fill socket volume
Phantom Limb Sensation
- Painless awareness of the amputated body part
- Incomplete sensation, often mild tingling
- This is NORMAL
Phantom Limb Pain
- Painful sensation of the amputated body part
- Can be constant or intermittent
- Described as cramping, squeezing, burning or shooting pain
Interventions for Phantom Pain (6)
- Desensitization and massage
- Compression
- Exercise
- Limb handling and use
- Modalities: TENS, US
- Psychological counseling
Mirror Therapy
- Pt. performs a movement with the unaffected limb
- Movement is viewed in mirror positioned in front of pt.
- Simultaneously, pt. attempts to perform the movement with their residual or phantom limb
