Amputee

Question 1

What major factors lead to amputations?

Answer 1

1. Congenital- birth to 10 y.o, congenital limb deficiency
2. Tumors- 11-20 y.o.
3. Trauma- most common in 21+
4. Disease- 60+; PVD, Infection, Thrombus, Embolism, Diabetes

Question 2

What are the two thought parties when it comes to amputations?

Answer 2

1. Save as much tissue as possible. Often leads to residual limbs not necessarily ideal for prosthetic, may require revision if does not heal
2. Amputate at level that ensure good healing and tissue recovery.
   BOTH: bevel the bone, muscles cut and secured, nerves stretched then cut and allowed to retract, skin flaps brought together

Question 3

What are post operative complications in amputees?

Answer 3

1. Pain in residual limb
2. Phantom Pain—pain felt in the portion of the extremity that was surgically removed
3. Phantom Limb—the sensation that the removed portion of the extremity still exists
4. Neuromas—nerve endings that have wadded up creating pain.
5. Contractures

Question 4

What should pre-operative programs entail?

Answer 4

1. Functional Mobility Assessment and Instruction: current level of independence determined and instruct on anticipated AD’s and adaptive equipment
2. pt education on post procedures, expectations, time frames
3. Initial post-op program instsruction

Question 5

What are the goals of a post-op program?

Answer 5

1. Prevent contractures
2. Improve strength and flexibility
3. Provide for edema control and shaping of residual limb
4. Establish independence of Functional Mobility
5. Psychological Support

Question 6

What does the post op program include?

Answer 6

1. Proper positioning
2. Pre prosthetic exercises
3. Control of edema and shaping of residual limb
4. Preprosthetic Ambulation
5. Functional Mobility Training
6. W/C considerations
7. Care of Skin

Question 7

What are common transfemoral contractures that need to be avoided?

Answer 7

1. Hip flexion
2. Hip ABduction
3. Hip ER

Question 8

What are common transtibial contractures that need to be avoided?

Answer 8

1. Hip flexion
2. Hip ABduction
3. Hip ER
4. Knee flexion

Question 9

What are recommended positions for transfemoral amputees?

Answer 9

1. Supine with pelvis level and hip in extension
   neutral rotation and neutral abduction/adduction
2. Lying prone with LE positioned in neutral rotation and abd/adduction
3. Early ambulation

Question 10

What are recommended positions for transtibial amputees?

Answer 10

-Same as transfemoral just be sure knee is in EXTENSION
-Avoid as much as possible:
pillows under residual limb,
prolonged sitting
Lying with residual limb in hip flexion, abduction. and external rotation, and knee flexion

Question 11

What are immediate post op preprosthetic exercises for Transfemoral?

Answer 11

Days 1-3

1. Isometrics
2. Gentle Partial AAROM
3. PRE to uninvolved joints as tol’d

Question 12

What are immediate post op preprosthetic exercises for Transtibial?

Answer 12

Days 1-3

1. Isometrics
2. Gentle Partial AAROM
3. PRE to uninvolved joints as tol’d
4. straight leg raises

Question 13

What are exercises for post op days 3-10 for both levels?

Answer 13

Add:

1. Active exercise of residual limb
2. Gentle resisted exercise for hip on amputated side with focus on hip extension and abduction

Question 14

What are exercises for post op days 10+ for both levels?

Answer 14

Add:
Transfemoral: gentle resisted exercise for hip on amputated side w/ focus on hip extension and abduction
Transtibial: gentle resisted exercise for knee on amputated side with emphasis on knee extension

Question 15

What are the goals of wrapping?

Answer 15

Edema control

Shaping for proper prosthetic fit and comfort

Question 16

What requirements must the wrapping meet?

Answer 16

1. Wrap distal to proximal creating a pressure gradient distal to proximal to assist the movement of fluid proximally
2. Wrap in oblique turns rather than circular turns to prevent a “tourniquet” effect from occurring.
3. Wrap with a minimum of two layers of wrap over the distal end of the residual limb.
4. Wrap should be free of wrinkles and gaps.
5. Wrap edges of incision carefully with upward pressure to prevent the formation of “dog-ears”.
6. Wrap transtibial residual limbs with anchoring above the knee and wrap transfemoral residual limbs with anchoring around the waist/pelvis