Amputations Flashcards
Amputation
- the removal of a limb or part of a limb due to trauma, disease, or surgical intervention
Major amputation levels
- below elbow
- above elbow
- below knee
- above knee
Etiology of amputations
- trauma (ex: accidents, war injuries)
- peripheral vascular disease (PVD)
- diabetes mellitus complications
- infections (ex: osteomyelitis = an infection/bacteria that eats away your bones)
- tumors (ex: osteosarcoma/cancer)
- congenital conditions
Peripheral artery disease (PAD)
- a common circulatory problem in which narrowed arteries reduce blood flow to the limbs
- increases the risk of developing non-healing wounds on the legs or feet
Etiology and risk factors of PAD
- atherosclerosis = build-up of plaque in the arteries
- smoking, diabetes, hypertension, and high cholesterol
- age = more common in people over age 50
- family history of cardiovascular disease
Signs and symptoms of PAD
- leg pain or cramping, especially when walking or exercising (intermittent claudication)
- numbness or weakness in the legs
- coldness in the lower leg or foot
- sores on toes, feet, or legs that won’t heal
Diagnosis and management of PAD
- ankle-brachial index (ABI) test = compares the blood pressure in the ankle with the blood pressure in the arm (low ankle-brachial index number can mean there is narrowing or blockage of the arteries in the legs)
- Doppler ultrasound, angiography
- lifestyle modifications = smoking cessation, exercise, and diet changes
- medications to manage symptoms and improve blood flow
- surgical interventions = angioplasty, stunting, or bypass surgery
Foot ulcers
- as a result of the disease, they can’t feel it or take care of it, the wound is just there, causing an ulcer
- leads to potentially an amputation
Conservative management to PAD treatment
- medicine and lifestyle changes
- foot and leg wound care
- minimally invasive procedures (balloons, stents, and other devices to restore blood flow to an extremity)
- surgical revascularization = open surgical techniques like limb bypass (to reroute blood supply around a blocked artery) and endarterectomy (removal of plaque from the artery)
- amputation
*really once the patient gets an amputation, they actually move on with their life just fine, as opposed to trying to live with the infection for months or years
Diagnostic criteria and evaluation of PAD
- clinical examination and history taking
- imaging = x-rays, MRI, and CT scans for trauma or tumor evaluations
- vascular studies for determining blood flow (ex: Doppler ultrasound)
Amputation surgery
- traumatic amputation = the incision line is not pretty
- amputation repaired (being conducted) = can be more precise and have more control to create an incision line (will leave some extra skin if possible to leave extra skin to flip it over to cover the wound
- wound vac = when not have enough skin and having to leave an opening
Medical and surgical management of amputations
- pre-surgical management = infection control, pain management, and psychological preparation
- post-surgical care = pain management, wound care, and prevention of complications like contractures
Post amputation management
Physical symptoms:
- pain = phantom limb pain, residual limb pain
- swelling and bruising
- limited range of motion
Psychological symptoms:
- depression
- anxiety
- body image disturbances
*when it’s below elbow or below knee, you can get the elbow or knee to stay in a bent position because it’s more comfortable to do that
Pain management:
- stump pain management
- phantom limb pain management
- musculoskeletal pain and disorders
Stump and prosthesis:
- stump and prosthetic hygiene
- fitting of the prosthesis
- the various types and use of prostheses
Psychosocial:
- bereavement of the lost limb
- depression management
- changes in social life
- societal perceptions of amputees
Daily needs:
- transportation
- couple relationships
- activities, return to work and sports
- fall prevention
Phantom pain
- pain that feels like it’s coming from a body part that is no longer there
- central nervous system remapping = brain areas previously responsible for the amputated limb may still produce pain signals
- peripheral nervous system = neuromas at the amputation site may trigger phantom pain
- sensations of burning, throbbing, stabbing, or shooting pain in the amputated limb
- pain may be triggered by changes in weather, pressure on the residual limb, or emotional stress
*people fall a lot after the amputation, especially with the leg amputated as they still think it’s still there
Management strategies to phantom pain
- medications = antidepressants, anticonvulsants, or opioids
- non-pharmacological interventions = mirror therapy, graded motor imagery, transcutaneous electrical nerve stimulation (TENS)
- psychological interventions = cognitive-behavioral therapy (CBT) and mindfulness techniques
- physical therapy = desensitization exercises and massage of the residual limb
