Chapter 3-Planning for Optimal Function in Amputation Surgery Flashcards

1
Q

What is the best solution for painful dysvascular limbs?

A

Early amputation at the most distal level with rehabilitation with a prosthesis

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2
Q

Why can’t diabetics have vascular reconstructive surgery?

A

They have small-vessel disease which is not treatable with vascular reconstruction

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3
Q

In World War II, what was the majority of lower-limb amputations?

A

Transfemoral

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4
Q

Energy expenditure increases due to what?

A
Level of amputation. 
Increase with increased height of amputation
Transtibial increase of 9%
Transfemoral 49%
Bilateral transfemoral 280%
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5
Q

What is often indicated for geriatric bilateral amputees?

A

Wheelchair locomotion and transfemoral amputation to prevent flexion contractures of the knees

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6
Q

What are clinical parameters to determine the distal most level of amputation?

A

Lowest palpable pulse
Skin temperature
Bleeding at surgery

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7
Q

What are non clinical parameters for determining the distal level of amputation?

A

Doppler ultrasonography
Xe measurements
Transcutaneous Po2 measurement
Fluorescein angiography

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8
Q

How do you measure transcutaneous Po2?

A

Warm skin to 44 degrees Celsius with a heated electrode

The electrode will then measure the oxygen emanating from the skin

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9
Q

What factors cannot be assessed during the preoperative period?

A
Alteration in collateral circulation
Decreased distal vascular runoff
Surgical technique
Nutritional status 
Infection
Concomitant medical illnesses
Postoperative care
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10
Q

What nutritional factor causes an adverse affect on morbidity and mortality in hospitalized patients?

A

Protein malnutrition

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11
Q

What is the increased percentage of energy requirement due to trauma or infection?

A

30-55%

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12
Q

What may increase the success rate of the amputation, if included in the preoperative stage?

A

Nutritional supplements

Start of antibiotics

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13
Q

During the operative period, how should the soft tissue be handled for dysvascular patients?

A

In a nontraumatic manner

Tissue forceps should be avoided

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14
Q

What is considered a long transtibial amputation length?

A

50% of the length of the remaining limb

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15
Q

What is considered a medium transtibial amputation length?

A

20-50%

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16
Q

What is considered a short transtibial amputation length?

A

less than or equal to 25%

17
Q

What soft-tissue management has been used to salvage a longer amputated limb?

A

Free-muscle transfers
Tissue expanders
Ilizarov technique

18
Q

Which type of limbs should not be closed right away following amputation?

A

Grossly contaminated traumatic wounds

Infected dysvascular limbs

19
Q

How do you avoid neuromas at the site of weight bearing?

A

Sharply divide the nerves and allow their retraction into sufficient soft-tissue cover

20
Q

What should occur in the immediate postoperative period after amputation?

A

Stumps should be splinted with well-padded rigid dressings to prevent joint contractures
IPOP- allow prosthetic ambulation

21
Q

What are the benefits of an IPOP?

A

Prosthetic ambulation
Decrease edema
Diminish postamputation depression

22
Q

Which type of patient benefit from IPOPs

A

Young traumatic amputees

23
Q

What are the downfalls of the IPOP?

A

Cause wound problems

24
Q

What should be considered prior to prosthetic fitting?

A

Impaired vision
Poor balance
Psychological problems
Additional musculoskeletal problems like RA