Chapter 3-Planning for Optimal Function in Amputation Surgery Flashcards
What is the best solution for painful dysvascular limbs?
Early amputation at the most distal level with rehabilitation with a prosthesis
Why can’t diabetics have vascular reconstructive surgery?
They have small-vessel disease which is not treatable with vascular reconstruction
In World War II, what was the majority of lower-limb amputations?
Transfemoral
Energy expenditure increases due to what?
Level of amputation. Increase with increased height of amputation Transtibial increase of 9% Transfemoral 49% Bilateral transfemoral 280%
What is often indicated for geriatric bilateral amputees?
Wheelchair locomotion and transfemoral amputation to prevent flexion contractures of the knees
What are clinical parameters to determine the distal most level of amputation?
Lowest palpable pulse
Skin temperature
Bleeding at surgery
What are non clinical parameters for determining the distal level of amputation?
Doppler ultrasonography
Xe measurements
Transcutaneous Po2 measurement
Fluorescein angiography
How do you measure transcutaneous Po2?
Warm skin to 44 degrees Celsius with a heated electrode
The electrode will then measure the oxygen emanating from the skin
What factors cannot be assessed during the preoperative period?
Alteration in collateral circulation Decreased distal vascular runoff Surgical technique Nutritional status Infection Concomitant medical illnesses Postoperative care
What nutritional factor causes an adverse affect on morbidity and mortality in hospitalized patients?
Protein malnutrition
What is the increased percentage of energy requirement due to trauma or infection?
30-55%
What may increase the success rate of the amputation, if included in the preoperative stage?
Nutritional supplements
Start of antibiotics
During the operative period, how should the soft tissue be handled for dysvascular patients?
In a nontraumatic manner
Tissue forceps should be avoided
What is considered a long transtibial amputation length?
50% of the length of the remaining limb
What is considered a medium transtibial amputation length?
20-50%
What is considered a short transtibial amputation length?
less than or equal to 25%
What soft-tissue management has been used to salvage a longer amputated limb?
Free-muscle transfers
Tissue expanders
Ilizarov technique
Which type of limbs should not be closed right away following amputation?
Grossly contaminated traumatic wounds
Infected dysvascular limbs
How do you avoid neuromas at the site of weight bearing?
Sharply divide the nerves and allow their retraction into sufficient soft-tissue cover
What should occur in the immediate postoperative period after amputation?
Stumps should be splinted with well-padded rigid dressings to prevent joint contractures
IPOP- allow prosthetic ambulation
What are the benefits of an IPOP?
Prosthetic ambulation
Decrease edema
Diminish postamputation depression
Which type of patient benefit from IPOPs
Young traumatic amputees
What are the downfalls of the IPOP?
Cause wound problems
What should be considered prior to prosthetic fitting?
Impaired vision
Poor balance
Psychological problems
Additional musculoskeletal problems like RA
