Amputations

Question 1

Functional limb

Answer 1

Muscles
Bones
Tendons
Nerves
Blood vessels

Question 2

Indications for amputations

Answer 2

Peripheral vascular disease
Trauma
Compartment syndrome
Infection
Tumours
Deformities

Question 3

Perioperative evaluation and preparation

Answer 3

Patient selection
Medical risk
Psychological evaluation
Antibiotics
Thromboprophylaxis
Level of amputation

Question 4

8 lower limb amputation

Question 5

Considerations made before an amputation

Answer 5

Major (above the ankle), minor (below the ankle)
Primary (No attempt at limb salvage), Secondary (failed limb salvage)
Priorities( Life over limb)
Deciding on the level of amputation.
Clinical (demarcation, functional status, physiological reserves)
Radiological (CTA, Doppler)
Adjuncts (Tcp02, thermography, skin perfusion pressure, dyes)

Question 6

Stability

Answer 6

Big toe bares most of the weight of the body
First metatarsal is the insertion of ankle stabilisers
NB muscles: Tibialis anterior and posterior, peroneal longus and brevis
Maintain weight bearing triangle to maintain balance.
Important to maintain foot arch.

Question 7

Minor amputations

Answer 7

Toe-ectomy
For disease isolated to the toe
Low morbidity
Good mobilisation
Technically easy

Question 8

Minor amputations

Answer 8

Trans-metatarsal
Includes ray amputations.
Good wound healing rates.
Patient still able to mobilise
Low morbidity.

Question 9

Minor amputation

Answer 9

Lisfranc: tarsometatarsal
Chopart: Transtarsal
Both historical:
equinus and equinavarus deformities
Difficulties with prosthesis.
Difficult mobilisation

Question 10

Minor amputations

Answer 10

Symes amputation
Through the ankle joint
Also historical
Patient can mobilise with good
rehabilitation

Question 11

Major amputations

Answer 11

BKA(below knee amputation).
Also called trans tibial.
Technically more challenging
Than an aka
80% wound healing rate
Requires less energy for
Prosthesis mobilisation

Question 12

Major amputations

Answer 12

Through knee amputation
Performed less frequently
Than bka and aka
Technically challenging
Good alternative to an aka
Disproportionate prosthesis
Joint to contralateral joint

Question 13

Major amputations

Answer 13

AKA(above knee amputation)
Good wound healing rate of 90%
Higher mortality rate than BKA
Requires more energy for prosthesis

Question 14

Major amputations

Answer 14

Hip disarticulation
50% mortality rate.
Should be avoided if possible
Difficult to fashion a functional prosthesis

Question 15

Upper limb amputations

Answer 15

Performed less frequently than lower limb
Technically more challenging
Good wound healing
Loss of fine motor function
Difficult to fashion prosthesis

Question 16

Complications

Answer 16

Infections
Necrosis
Contractures
Phantom pain
Muscle dystrophy
Neuroma
Emotional damage

Question 17

Post operative care

Answer 17

Wound care
Nutrition
Medication
REHABILITATION