Amputation Managment

Question 1

How can diabetes cause damage to microvasculature?

Answer 1

Peripheral neuropathy- undetected injury- poor circulation and poor healing- infection- osteomyelitis (infection of bone)

Question 2

Benefits of amputation?

Answer 2

• pain relief
• improved mobility
• prevention of further infection
• prevention of growth/spread of tumour
• quality of life
• life saving

Older patients with PAD- frequent dressings, reduced mobility, lack of social contact due to malodorous ulcers and pain

Younger patients with disabilities/ following RTA- frequent hospital visits and operations, lack of social contact and difficulty accessing areas, reduced mobility, pain.

Question 3

Complications of amputation?

Answer 3

• pain (post-operative, neural and phantom) phantom sensation, immobility and wheelchair dependence
• infection, injury or failure to heal- further resection
• falls, grief, contractures, biomechanical compensations, psychological impact and death
• prosthetic complications- COG, muscle action, uncomfortable, sore, rubbing

Question 4

MDT members?

Answer 4

Immediate team-
Consultant, medical team, nursing team, tissue viability nurse, diabetes team, psychologist, social worker, pain management team, pharmacist, dietician, physiotherapist and OT

Wider team-
Prosthetic services, social services/carers, wheelchair centre, GP, district nurse, mental health team

Question 5

Role of Physiotherapist?

Answer 5

• contribute to decision to amputate and which level
• pre- operative assessment
• early post-Op rehabilitation
• respiratory care
• wheelchair use
• discharge planning
• follow- up rehabilitation
• gait re-education
• education/support/advice
• prosthetic rehabilitation

Question 6

Early post-operative rehab ?

Answer 6

• residual limb assessment and management
• compression therapy
• Massage stump
• active exercises (PIRPAG)
• Bed mobility
• transfers- bed to chair, bed to wheelchair, wheelchair to toilet
• safety
• falls awareness- on and off floor, crawl/shuffle to furniture
• mobility

Question 7

What are the types of early walking aids?

Answer 7

Pneumatic post amputation mobility aid

Femurette

Question 8

Advantages and disadvantages of PPAMaid?

Answer 8

TFA and TTA
Can be used at 5 days post-op

Common practice to start at 10 days

Can aid oedema reduction

PWB- partial weight bearing

Looks nothing like a limb

Start with parallel bars and progress gradually to quad sticks

Can only be used to fixed knee, hip hitching style for TTA
Does not work well with TFA

Question 9

Advantages and disadvantages to a femurette?

Answer 9

TFA with ‘fixed’ or ‘free’ knee options

Can be used from 1st day post-op

FWB

Used to practice stairs, outdoor mobility

More like a prosthesis

Patient can don themselves

Only for TFAs

Can progress to sticks

Question 10

What to include In a lower limb prosthetic rehab?

Answer 10

• weight transference, side stepping, backwards walking, heel strike, stride stand
• single leg stand, tight rope walking, step ups, grape vine
• wobble cushions/boards, STS
• un-squash ball under sound foot
• rolling small ball under sound foot
• sidestep over with prosthetic leg
• step forwards over an object
• upper limb exercises
• wall squat
• resisted walking
• carrying objects

Question 11

Outcome measures to use for prosthesis?

Answer 11

• locomotor capabilities index
• distance walked over a certain time
• 4 square step tests
• balance tests
• 3m timed up and go
• falls measure