Amputations Flashcards
What is the difference of sickness impact profile and return to work btw amputation and reconstruction of lower limb?
No significant difference at two years; most important factor to determine patient-reported outcome is the ability to return to work
In a patient with lower extremity trauma, what has the most impact on the decision to attempt limb salvage versus amputation?
1) Severity of soft tissue injury
2) Absence of plantar sensation; not a contraindication to reconstruction
A through-knee disarticulation has been shown to have what advantage over a traditional above-knee (transfemoral) amputation?
Less energy expenditure with ambulation; Metabolic cost of walking increases with more proximal amputations
What is the increase in energy expenditure of various lower extremity amputations?
Syme- 15% BKA- 25-45% AKA- 75-100% BKA + BKA - 40% AKA + BKA - 118% AKA + AKA - >200%
What is the most proximal level of amputation that a child can undergo and still maintain a normal walking speed without significantly increasing their energy cost?
Through-the-knee amputation
What are some contraindications to hyperbaric oxygen treatment for wound healing?
1) chemo or radiation therapy
2) pressure-sensitive implanted medical device (automatic implantable cardiac defibrillator, pacemaker, dorsal column stimulator, insulin pump)
3) undrained pneumothorax
What factors are viewed as favorable for wound healing?
1) albumin > 3.0 g/dL
2) ischemic index > .5
measurement of doppler pressure at level being tested compared to brachial systolic pressure
3) transcutaneous oxygen tension > 30 mm Hg (ideally 45 mm Hg)
4) toe pressure > 40 mm Hg (will not heal if 0.45
6) total lymphocyte count (TLC) > 1500/mm
Myodesis of which muscle group is most important for optimal outcome after transfemoral amputation?
Adductors; 5-10° of adduction
What level around the joint line is appropriate for an above the knee amputation? BKA?
AKA-12cm above the joint line
BKA- 12-15cm below joint line
How do through the knee amputations compare to AKA and BKA in outcomes?
1) slower self-selected walking speeds than BKA
2) similar amounts of pain compared to AKA and BKA
3) worse performance on the Sickness Impact Profile (SIP) than BKA and AKA
4) physicians were less satisfied with the clinical, cosmetic, and functional recovery
5) require more dependence with patient transfers than BKA
What is the most common complication of pediatric amputations?
Bone overgrowth
What additional procedure is important when performing a transmetatarsal amputation?
Achilles lengthening
What are two important factors when considering a Syme amputation?
1) Stable heel pad
2) patent posterior tibialis a.
What additional procedure is important when performing a Chopart amputation?
lengthening of the Achilles tendon and transfer of the tibialis anterior to the talar neck; prevents equinovarus
