Basics Flashcards
1
Q
Old terminology:
- AK - above knee
- BK - below knee
- Stump
A
New terminology:
- transfemoral (AK)
- transtibial (BK)
- residual limb (stump)
2
Q
causes of amputations
A
- PVD (75%): dec. b/c of vascular sx and wound healing techniques; 2/3 also have diabetes
- trauma: MVA, war, GSW
- tumors: limb salvage more prevalent due to chemo and imaging
3
Q
levels of UE amputation
A
- Partial hand disarticulation (Loss of thumb - index finger or toe transfer should be considered)
- Wrist disarticulation
- Transradial
- Transcarpal (includes metacarpal bones)
- Elbow disarticulation
- Transhumeral
- Shoulder disarticulation (removal of entire humerus)
- Interscapulothoracic (removal of humerus, scapula, and part of clavicle)
- Note: in UE amputations, soft tissue coverage at the end of the residual limb is not as important as a LE amputation b/c UE are NWB
4
Q
levels of LE amputation
A
- Partial toe (excision of any part of 1+ toes)
- Toe disarticulation (disarticulation at the 3rd MTP joint)
- Partial foot/ray resection (resection of the 3rd, 4th, 5th metatarsals and digits)
- Transmetatarsal (amputation through the midsection of all metatarsals; Lisfranc - before tarsal bones; Chopart - after tarsal bones)
- Ankle disarticulation (Syme’s)
- Transtibial (short, standard, long)
- Knee disarticulation (amputation through the knee joint; femur intact)
- Transfemoral (long, standard, short)
- Hip disarticulation (amputation through hip joint; pelvis intact)
- Hemipelvectomy (resection of lower half of pelvis)
- Van Ness Rotationplasty
- Hemicorporectomy (amputation both lower limbs and pelvis below L4-5 level)
5
Q
Syme’s ankle disarticulation
A
- attachment of heel pad to distal end of tibia
- may include removal of malleoli and distal tibial/fibular flares
- Functionally a WB level (but not cosmetically favored)
6
Q
levels of transtibial (BK) amputations
A
- Long transtibial > 50% of tibial length
- Transtibial 20-50% of tibial length; standard; preferred level is at taper of gastroc
- Short transtibial < 20% of tibial length
- determine % length by comparing opposite side
- fibula best when 1cm shorter than tibia
7
Q
levels of transfemoral (AK) amputations
A
- Long transfemoral >60% of femoral length
- Transfemoral 35-60% of femoral length
- Short transfemoral < 35% of femoral length
- determine % length by comparing opposite side
8
Q
Van Ness Rotationplasty
A
- ankle joint becomes a functional knee joint
- can run and jump with a prosthesis
- often used in situations of cancer
9
Q
why would a knee disarticulation not be a great idea
A
need room for componentry and want at least 4 inches for a good lever arm; the longer the lever arm, the better
10
Q
energy requirements for TT vs TF
A
TT = 33% greater energy required TF = 66% greater energy required
11
Q
surgical process goals
A
- Remove necessary part
- Allow for good wound healing
- Create a residual limb for optimal prosthetic fit and function
- Skin flaps: broad as possible
- Scar: pliable, painless, nonadherent
12
Q
types of surgical closures
A
- Equal length posterior and anterior flaps
- Long posterior flaps
- Skew flap
13
Q
equal length posterior and anterior flaps (closure)
A
- Scar is at bottom of the residual limb
- For well-vascularized patients/no vascular impairment
14
Q
long posterior flap (closure)
A
- Scar is anterior over distal tibia (beware of bone adherence)
- For compromised circulation b/c posterior tissues have better blood supply than anterior tissues
15
Q
skew flap (closure)
A
- Scar is angular medial-lateral, thus places scar away from bony prominences
- May be better than long posterior flap
- Also for compromised circulation
