Amutations

Question 1

Most common amputations?

Answer 1

• Lower amputatoins

- 80%-90%

Question 2

Causes of Amputation

Answer 2

• Peripheral Vascular Disease (Major)
• Diabetes, smoking,
• Trauma (Secondary)

Question 3

Levels of amputations

Answer 3

• Partial Toe
• Toe Disarticulation
• Partial Foot / Ray resection
• Transmetatarsal
• Symes - ankel disarticulation
• Below Knee (unilateral/bilateral)
  ie: Long transtibial, Transtibial, Short transtibial
• Knee Disarticulation
• Above knee
  ie: Long Transfemoral, Transfemoral, Short Transfemoral
• Hip disarticulation
• Hemipelvectomy
• Hemicorporectomy

Question 4

Partial Toe

Answer 4

• Excision of any part of one or more toes

Question 5

Toe Disarticulation

Answer 5

• at the MTP joint

Question 6

• Partial foot / ray resection

Answer 6

• 3rd, 4th, or 5th MT’s and digits

Question 7

Transmetatarsal

Answer 7

• amputation through the medsection of all MT’s

Question 8

Symes - Ankle Disarticulation

Answer 8

• Heel pad attached distally to the end of the tibia

Question 9

Advantage of the Symes

Answer 9

• can bear weight on residual limb without prosthesis

Question 10

Below knee Unilateral

Answer 10

• likely to become functional prosthetic users

Question 11

Below Knee Bilateral

Answer 11

• can become functional prosthetic users

Question 12

Below Knee Long Transtibial

Answer 12

• > 50% of Tibial Length

Question 13

Below Knee Transtibial

Answer 13

• 20%-50% of Tibial Length

Question 14

Below Knee Short Transtibial

Answer 14

• < 20% of Tibial Length

Question 15

Knee Disarticulation

Answer 15

• Femur intact

Question 16

Above Knee Unilateral

Answer 16

• Elderly unilateral more difficulty becoming functional prosthetic users

Question 17

Above Knee Bilateral

Answer 17

• most bilateral do not become functional prosthetic users

Question 18

Above Knee Long Transfemoral

Answer 18

• > 60% of Femoral Length

Question 19

Above Knee Transfemoral

Answer 19

• 35%-60% of Femoral Length

Question 20

Above Knee Short Transfemoral

Answer 20

• < 35% of Femoral Length

Question 21

Hip Disarticulatoin

Answer 21

• Pelvis intact
• Result of tumors or severe trauma
• small 1% of amputations

Question 22

Hemipelvectomy

Answer 22

• Lower 1/2 of pelvis
• results of tumors or sever trauma
• small % of amputations

Question 23

Hemicorporectomy

Answer 23

• Bilateral LE’s and Pelvis below L4-L5
• Result of tumors or severe trauma
• Small % of amputations

Question 24

Goals of Surgery

Answer 24

• Remove what needs to be removed
• Allow for wound healing
• Construct a residual limb for optimal prosthetic use

Question 25

How should a optimal residual limb look and feel?

Answer 25

• At the lowest possible level of compatible with healing
• Scar needs to be pliable, painless, and non-adherent
• Bone ends are rounded and beveled
• Muscle ends are stabilized by suturing them together to other muscles fascia or bone

Question 26

Bone Bridge

Answer 26

• Dr Ertl

- Distal ends of the Tibia and Fibula for weight bearing

Question 27

Oldest Method of Soft dressings

Answer 27

• Still commonly used

Question 28

Elastic Wraps

Answer 28

• Soft Dressing

- require frequent re-application

Question 29

Shrinker

Answer 29

• Soft Dressing
• Can be used after the wound heals
• Must have a good distal contact

Question 30

Advantages to Soft Dressing

Answer 30

• Inexpensive
• Light weight
• Can be removed / Laundered / easy access to incision

Question 31

Disadvantages of Soft Dressing

Answer 31

• Poor edema control and poor protection
• Elastic wrap requires skill for proper application
• Needs frequent re-wrapping

Question 32

Semi-Rigid Dressing

Answer 32

• Several Types

- IPOP Immediate Post Op Prosthesis

Question 33

Advantages to Semi Rigid Dressing

Answer 33

• IPOP (the best)
• Significantly better edema control
• Most can be removed to observe wound
• Allows early ambulation on plylon
• Very limited intial weight bearing
• Weight bearing alarm can be built into pylon

Question 34

Disadvantages of Semi Rigid Dressing

Answer 34

• Relatively expensive
• Cannot be applied by the pt
• Some have no access to incision

Question 35

Rigid Dressing

Answer 35

• Plaster or Fiberglass or plastic shell with attachment for pylon and foot
• Plaster dressings are not removable, other types my be removable

Question 36

Advantages to Rigid Dressing

Answer 36

• Best Edema control and pain of residual limb control
• Allows early ambulation on pylon
• Very limited early weight bearing
• Allows early prosthetic fitting

Question 37

Disadvantages of Rigid Dressing

Answer 37

• Expensive
• Requires skilled application
• Does no allow easy wound inspection
• Requires close supervision during wound healing