Amputations

Question 1

What are the indications for amputation

Answer 1

• Ischaemic:
  
  • Peripheral vascular disease (80-90% of all cases)
  • Buerger’s disease
  • AV fistulae
• Trauma:
  
  • Unsalvageable limbs
  • Burns
  • Frostbite
• Malignancy:
  
  • Bone
  • Soft tissue
• Infection/neuropathy:
  
  • Osteomyelitis
  • Necrotizing fasciitis
  • Charcot neuroarthropathy
• Pain, neurological damage

Question 2

What are the early complications of amputations

Answer 2

Specific early complications (up to 1 month):- Psychological and social implications Haematoma and wound infection Phantom limb pain Skin necrosis

Question 3

Why does phantom limb pain occur

Answer 3

Due to the sensory cortex ‘believing’ the limb is still present

Question 4

What are the late complications of amputations

Answer 4

Specific late complications (beyond 1 mth):- Osteomyelitis Stump ulceration Stump neuroma Fixed flexion deformity of the knee Difficult in mobilizing Spurs and osteophytes in the underlying bone

Question 5

What is the prognosis of amputation surgery

Answer 5

Operative mortality is 20% 1-year survival is 50%

Question 6

What considerations must be made before amputation?

Answer 6

Psychosocial implications Future mobility OT involvement Level of amputation- high enough to ensure healing but increased mortality with above vs below knee amputations

Question 7

What types of foot amputation are there?

Answer 7

• Toe amputation: With metatarsal head
• Ray amputation: V shaped incision either side of the affected digit to the base of the metatarsal. Used if necrosis of digit and muscles of foot.
• Forefoot: Transmetatarsal

Question 8

What types of lower limb amputation are there?

Answer 8

Below knee amputation Above knee amputation Hindquarter amputation