Amputations Flashcards
forequarter (scapulothoracic)
surgical removal of the upper extremity including the shoulder girdle
hemicorpeorectomy
surgical removal of the pelvis and both lower extremities
hemipelvectomy
surgical removal of one half of the pelvis and the lower extremity
transverse tarsal (chopart’s)
amputation through the talonavicular and calcaneocuboid joints.
the amputation preserves the plantar flexors, but sacrifices the dorsiflexors often resulting in an equinus contracture
tarsometatarsal (lisfranc)
surgical removal of the metatarsals. the amputation preserves the DF and PF
Socket
- interface between the residual limb and the prosthesis
- a properly fitting socket will disperse the pressure experienced in WB throughout teh limb, providing total contact with the surface. Certain areas of teh residual limb are more pressure tolerant and can handle greater pressure than others. generally speaking muscular areas are more tolerant than bony surfaces,
- sockets can take on many shapes and sizes, however, the most common design for a transfemoral prostheis is an ischial containment socket, while one of the more common designs for a tanstibial prosthesis is a total surface bearing or patellar tendon bearing socket
liner
liner plays an important role in the comfort and health of individuals using a prosthesis. gel liners, commonly made of silicone, are used for a variety of purposes including cushioning the residual limb and hosting a suspension mechanism such as a pin or lanyard. some liners are used to maintain suspension through negative pressure such as what is seen with a transfemoral seal-in liner.
-liners are for teh most part non-breathable which means tha perspiration can buildup throughout the day. this can result in fricction issues and cause irritation on the skin of the residuum. as a result, frequent doffing of teh liner may be required to dry it off along with the residual limb. liners must be carefully washed and dried to mainatin a hygenic environment. gel sheaths can be applied underneath the liner directly on teh skin of teh residual limb and can serve to relieve irritation when using the prosthesis
insert
flexible or soft insert can be used to accomodate for space in the prosthetic socket. soft inserts, generally made from a foam material, offer improved cushioning on the residual limb during WB. Flexible inserts are usually made of plastic and similar to a foam insert can imrpove the comfort and fit of teh prosthesis. unlike a foam insert which can offer some shock absoprtion the hard insert relieves pressure through a series of buildups and reliefs molded into the insert
sock
normal for an individual with limb loss to experience a decrease in residual limb volume, especially in teh first year. in order to accomodate for this space, prosthetic socks are used to maintain a congruent and comfortable fit. prosthetic socks come in various sizes and material types, including cotton, wool and material types.
commonly encountered plys are 1,3 and 5 ply.
a general rule of thumb is that when the number of ply socks exceed 12-15 teh prosthetist should be notified as a recasting may be required. some socks are split ply, and will have greater/lesser ply distally than proximally socks must be carefully applied as to eliminate any wrinkles, otherwise teh wearer may experience discomfort or breakdown in the area of increased pressure
hygiene of residual limb
carefully wash, inspect and mainatain to prevent the formation of wounds or infection.
wear schedule of prosthesis
- “break-in” schedule is normally prescribed for teh first few weeks of wear. allows for slow accomodation to teh sensation of WB through teh residuum.
- general rule is to start with one hour a day of total wear time, with half of the time spent ambulating.
- every 30 min or immediately after walking inspect skin.
- if good an hour is added each day while still respecting the 50% rulle of rest:use.
Fit issues of Prosthesis
-can be managed through manipulation of sock-ply, alignment of the liners in the socket and training the patient on how to dynamically adjust the fit to accomodate fluctuations in the size of teh residual limb throughout the day.
what red flags should we educate the patient on when wearing prosthesis
how to prevent, identidy, and report any issues associated with their residual limb as soon as possible in order to prevent secondary complications.
-this includes preventing skin breakdown through daily inspections and hygiene, identifying abrasions or wounds that have formed and discontinuing wearing the prosthesis until the limb has been examined by a physician
Pre-prosthetic phase of rehabilitation
immediately post- amputation. 6 weeks
-PT focuses on protetcing thelimb, preventing contractures, develop single limb mobility skills, and preparing the patient for theprosthetic phase of rehab.
-may be fitted with an immediate post-operative prosthesis which allows for immediate WB using a temporary device. toward the end pt evaluated for their first prosthesis once the staples and sutures have healed
Complications: hypersensitivity
hypersensitivity of the residual limb can significantly impede or even prevent the appropriate fit and functional use of a prosthesis. specific desensitization techniques and early fitting of a temporary prosthesis are key components in post-amputation rehab. WB, massage, tapping and residual limb wrapping are all commonly utilized interventions that facilitate desensitization
