Amputation Types Flashcards
What is the definition of amputation?
Amputation is the complete removal of an injured or deformed body part.
The main indications for amputation include = ?
- peripheral vascular disease,
- arterial occlusion
- embolism
- aneurysm
- diabetic limb disease,
- necrotizing fasciitis
- severe trauma
- chronic infection
- tumors
- nerve injury
- congenital anomalies
What is the primary goal of modern amputation surgery?
To reconstruct a functional end organ, enabling the use of a prosthesis and optimizing remaining limb function.
Which population is most affected by amputations?
- African Americans (4:1 ratio)
- Higher incidence in men except for malignant tumors
- Main causes are vascular disease (54%) and trauma (45%)
What are the epidemiological statistics related to amputations in the U.S.?
- 185,000 individuals undergo amputations annually
- 1.35 amputations per 1,000 people
- 80% are for vascular disease; 25% mortality at 1 year
- 67% at 5 years
What are the distribution percentages of lower extremity amputation types?
- The most common were:
- toe (33.2%)
- transtibial (28.2%)
- transfemoral (26.1%)
- foot amputations (10.6%)
- Distibution
- Transtibial (59%)
- Transfemoral (35%)
- Syme’s (3%)
- Knee disarticulation (1%)
- Hip disarticulation (2%)
- Hemipelvectomy and hemicorporectomy (< 1%)
Describe the differences between toe amputation, ray amputation, and transmetatarsal amputation.
- Toe amputation removes the phalanges
- Ray amputation removes the toe and metatarsal
- Transmetatarsal amputation involves partial foot amputation through the metatarsals.
What shoe modifications are needed for transmetatarsal amputations?
Extended carbon fiber foot plate
steel shank in the sole
Custom toe filler
rigid rocker bottom sole
Compare Lisfranc and Chopart amputations.
- Lisfranc involves tarso-metatarsal disarticulation.
- Chopart removes the forefoot and midfoot, sparing talus and calcaneus.
- Has a high risk of poor healing and equinus deformity due to loss of tibialis anterior insertion.
What are the benefits of Syme’s amputation?
- distal weight-bearing
- longer residual limb
- less energy loss
- ambulation without a prosthesis
- proprioception
- preservation of distal growth plate in children
Why is the transtibial amputation the preferred surgical technique?
Long posterior flap technique, preserving muscle bulk with sensitivity, and typically using IPOD for dressing.
What tibial length is optimal for prosthetic fitting after a transtibial amputation?
- 5-7 inches
- less than 3.5 inches is not feasible
Compare myodesis and myoplasty in amputation surgery.
- Myodesis involves suturing muscle to bone, providing stronger stabilization.
- Myoplasty sutures opposing muscles together for padding but is used when myodesis is not feasible.
What are the advantages and challenges of knee disarticulation?
- Advantages include preserved adduction angle and distal femur’s tolerance for end-bearing;
- Challenges include bulbous residual limb, making prosthetic fitting difficult.
How has technology improved outcomes for transfemoral amputees?
Improved socket designs, better suspension systems, and dynamic prosthetic components enhance energy efficiency and reduce pain.
What is the primary indication for hip disarticulation?
Life preservation after severe trauma, advanced ischemic disease, necrotizing fasciitis, sepsis, or tumor.
What is hemipelvectomy, and why is it performed?
- It involves removal of the lower limb and part of the pelvis
- Typically for malignancy or severe trauma.
What is rotationplasty, and in what cases is it used?
Rotationplasty involves rotating the lower leg and reattaching it to function as a knee joint, used in cases of osteosarcoma or congenital differences.
What are the main concerns and advantages of rotationplasty?
Concerns include cosmetic appearance, while advantages include increased mobility and natural knee function.
Describe osteointegration in amputation surgery.
It involves implanting a fixture in the femur that allows direct attachment of a prosthesis, eliminating the need for suspension sockets.
What is the Ertl procedure?
An osteomyoplastic amputation with tibia-fibula synostosis, enhancing stability and prosthetic use.
List the levels of upper extremity amputations.
Transradial, transhumeral, elbow disarticulation, and forequarter amputation.
What is the Krukenberg procedure?
A surgical separation of the radial and ulnar rays, forming pincers for prehension, used for below-elbow amputees.
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