Amputation Types Flashcards

1
Q

What is the definition of amputation?

A

Amputation is the complete removal of an injured or deformed body part.

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2
Q

The main indications for amputation include = ?

A
  • peripheral vascular disease,
  • arterial occlusion
  • embolism
  • aneurysm
  • diabetic limb disease,
  • necrotizing fasciitis
  • severe trauma
  • chronic infection
  • tumors
  • nerve injury
  • congenital anomalies
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3
Q

What is the primary goal of modern amputation surgery?

A

To reconstruct a functional end organ, enabling the use of a prosthesis and optimizing remaining limb function.

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4
Q

Which population is most affected by amputations?

A
  • African Americans (4:1 ratio)
  • Higher incidence in men except for malignant tumors
  • Main causes are vascular disease (54%) and trauma (45%)
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5
Q

What are the epidemiological statistics related to amputations in the U.S.?

A
  • 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
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6
Q

What are the distribution percentages of lower extremity amputation types?

A

- 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%)
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7
Q

Describe the differences between toe amputation, ray amputation, and transmetatarsal amputation.

A
  • Toe amputation removes the phalanges
  • Ray amputation removes the toe and metatarsal
  • Transmetatarsal amputation involves partial foot amputation through the metatarsals.
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8
Q

What shoe modifications are needed for transmetatarsal amputations?

A

Extended carbon fiber foot plate
steel shank in the sole
Custom toe filler
rigid rocker bottom sole

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9
Q

Compare Lisfranc and Chopart amputations.

A

- 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.
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10
Q

What are the benefits of Syme’s amputation?

A
  • distal weight-bearing
  • longer residual limb
  • less energy loss
  • ambulation without a prosthesis
  • proprioception
  • preservation of distal growth plate in children
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11
Q

Why is the transtibial amputation the preferred surgical technique?

A

Long posterior flap technique, preserving muscle bulk with sensitivity, and typically using IPOD for dressing.

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12
Q

What tibial length is optimal for prosthetic fitting after a transtibial amputation?

A
  • 5-7 inches
  • less than 3.5 inches is not feasible
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13
Q

Compare myodesis and myoplasty in amputation surgery.

A

- Myodesis involves suturing muscle to bone, providing stronger stabilization.

- Myoplasty sutures opposing muscles together for padding but is used when myodesis is not feasible.

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14
Q

What are the advantages and challenges of knee disarticulation?

A
  • Advantages include preserved adduction angle and distal femur’s tolerance for end-bearing;
  • Challenges include bulbous residual limb, making prosthetic fitting difficult.
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15
Q

How has technology improved outcomes for transfemoral amputees?

A

Improved socket designs, better suspension systems, and dynamic prosthetic components enhance energy efficiency and reduce pain.

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16
Q

What is the primary indication for hip disarticulation?

A

Life preservation after severe trauma, advanced ischemic disease, necrotizing fasciitis, sepsis, or tumor.

17
Q

What is hemipelvectomy, and why is it performed?

A
  • It involves removal of the lower limb and part of the pelvis
  • Typically for malignancy or severe trauma.
18
Q

What is rotationplasty, and in what cases is it used?

A

Rotationplasty involves rotating the lower leg and reattaching it to function as a knee joint, used in cases of osteosarcoma or congenital differences.

19
Q

What are the main concerns and advantages of rotationplasty?

A

Concerns include cosmetic appearance, while advantages include increased mobility and natural knee function.

20
Q

Describe osteointegration in amputation surgery.

A

It involves implanting a fixture in the femur that allows direct attachment of a prosthesis, eliminating the need for suspension sockets.

21
Q

What is the Ertl procedure?

A

An osteomyoplastic amputation with tibia-fibula synostosis, enhancing stability and prosthetic use.

22
Q

List the levels of upper extremity amputations.

A

Transradial, transhumeral, elbow disarticulation, and forequarter amputation.

23
Q

What is the Krukenberg procedure?

A

A surgical separation of the radial and ulnar rays, forming pincers for prehension, used for below-elbow amputees.

24
Q

.

A

.

25
Q

Compare transradial and transhumeral amputation levels.

A
  • Transradial is at the junction of the proximal 2/3 and distal 1/3 of the forearm.
  • Transhumeral is at the middle third of the humerus.
26
Q

How does prosthetic fitting differ between transradial and transhumeral amputations?

A
  • Transradial amputations typically offer better prosthetic control due to preserved forearm muscles.
  • Transhumeral amputations require more complex prostheses for arm function.
27
Q

What factors influence the selection of amputation level?

A

Optimal function, limb preservation, patient comorbidities, vascular status, and potential for prosthetic use.

28
Q

Describe the functional differences between transtibial and transfemoral prosthetics.

A
  • Transtibial prosthetics allow for more natural gait patterns.
  • Transfemoral prosthetics require more energy and complex knee components.
29
Q

How does vascular health impact surgical technique selection in amputation?

A

Poor vascular health favors myoplasty over myodesis to ensure soft tissue healing.

30
Q

What is the impact of limb length on energy expenditure with prosthetics?

A

Longer residual limbs generally reduce energy expenditure and improve gait efficiency.

31
Q

Why is distal muscle stabilization critical in amputation surgery?

A

It prevents muscle retraction, reduces contractures, and improves prosthetic function.

32
Q

What are the psychological impacts of amputation?

A

Amputation can lead to grief, depression, body image issues, and anxiety, necessitating psychological support.

33
Q

How do myodesis and myoplasty differ in terms of contracture prevention?

A

Myodesis reduces contracture risks due to direct muscle-to-bone attachment

Myoplasty may not be as effective in contracture prevention.

34
Q

What is the significance of the long posterior flap technique in transtibial amputation?

A

It helps maintain muscle bulk and sensitivity, improving the potential for successful prosthetic use.

35
Q

What are the common causes of upper extremity amputations?

A

Trauma, cancer, vascular disease, and congenital anomalies.

36
Q

How does prosthetic suspension vary between transtibial and transfemoral amputations?

A
  • Transtibial suspension often relies on vacuum or suction systems
  • Transfemoral may use belts or advanced suspension liners.
37
Q

What are the most common complications following amputation?

A

Phantom limb pain, infection, wound healing issues, and prosthetic fitting challenges.

38
Q

Describe forequarter amputation and its main indication.

A

It involves removal of the upper limb, clavicle, and scapula, mainly performed for malignancies.

39
Q

What are the potential long-term outcomes for patients with lower extremity amputations?

A

Outcomes include improved mobility with prosthetic rehabilitation, risk of contralateral limb amputation, and variable mortality rates based on comorbidities.