Amputee & Surgery Flashcards
List the causes for amputation.
i) Congenital
ii) Trauma
iii) Peripheral Vascular Disease (20%)
iv) Diabetes (50%)
v) Tumour
vi) Infection
vii) Extra appendage
In what age range to the rate of amputations peak? In what age range do they start?
i) 70-80 (M > F)
ii) 45-50 (M > F)
What determines the level of amputation?
i) Functional expectation
ii) Patient preference
iii) Region/severity of disease
iv) Ability to heal
v) Level of election
What is a “level of election”?
A predetermined series of sites for amputation that were derived from previous high stump survival rates and to fit old prosthesis. These sites are often through a joint.
What criteria marks the prediction of healing transtibial (TT) level?
i) Ankle BP < 50mmHg
ii) Line of demarcation
iii) ankle/brachial BP level <0.3
iv) Transcutaneous oxygen level <30
How common is phantom sensation?
Universal.
How common is phantom pain?
Incidence not known. Risk factors include traumatic cause for amputation and pain in limb prior to amputation. While it usually persists, intensity can decrease over time.
What options are available for treating phantom limb pain?
i) pharmacotherapy (ex. opoids, etc.)
ii) surgical (revision, nerve block, CNS stim etc.)
iii) adjuvant (ex. mirror therapy, ultrasound, biofeedback etc.)
What are the options available for edema control following amputation?
i) Tensors
ii) Shrinkers
iii) Casts
iv) Removable rigid dressings
What are the surgery goals of amputation?
i) Well padded
ii) Will fit a prosthesis
iii) Comfortable
iv) Will heal
What are two techniques a surgeon can use to help skin heal?
i) Close without any tension on the skin
ii) Do not use toothed forceps
How is the nerve severed and fixed in amputation surgery?
i) Pull down
ii) Tie high
iii) Sever
iv) Let go
v) Allow neuroma to form in well padded place.
How is muscle severed and fixed in amputation?
i) myoplasty: muscle suture to muscle, pull over bone
ii) myodesis: muscle suture to bone (usually adductors & med. hamstring)
iii) trim excess
How are blood vessels managed in amputation surgery?
Ligated.
How are bones managed in amputation surgery?
Strip periosteum 1 cm from cut end.
What are two types of suturing techniques? Are any better or worse than others?
i) Skew/Sagittal flaps that are brought together medially and cross the distal tibia sagittally.
ii) Long posterior flap: wrapped over the residuim and sutured anteriorly
What is osseointegration? Name one indication.
i) The process of attaching a fixture into the bone that extends out of the limb. Mostly TF, however some are TT.
ii) Inability to tolerate prosthetic socket.
What are the contraindications to osseointegration?
i) infection
ii) > 100kg
iii) immunocompromise
iv) ? diabetes
v) ? smoking
What is an ertl procedure?
Bridging between the tibia and fibula post amputation surgery.
What are the benefits of an ertl procedure?
i) end bearing
ii) cylindrical shape
iii) no floating fibula
iv) no bony overgrowth
v) better ambulation subscore
vi) better frustration subscore
Note: longer and more complicated surgery
What are important rehabilitation considerations in the pre-prosthetic/non-prosthetic population?
i) transfers
ii) iADLs
iii) locomotion
iv) exercise (strength, balance, ROM)
What outcome measures are valid in amputee rehabilitation?
i) Special Interest Group in Amputee Medicine (SIGAM) Mobility Grades
ii) Functional Independence Measure (FIM)
Describe the SIGAM mobility scores.
I: Non-limb user: no functional prosthesis
II: Therapeutic: Use of prosthetic ONLY for therapeutic purpose
III: Limited: Walks <50m with or without walking aid
IV: Impaired: Walks >50m with walking aid
V: Independent: Walks >50m without walking aid
VI: Normal or near normal walking
What is the major benefit of microprocessor knee prosthetics? What is a necessary criteria?
i) The ability to adapt to different walking speeds (accelerometer, position sensors etc.)
ii) Equal stance phase stability
