EXAM 2: WK 2 Flashcards
Surgical Conditions - levels of amp
- viewed as a failure of treatment if they need an amp
- viewed as their body not being complete
- psychological stigma
- removal of diseased, ischemic, mangled, non functioning tissue
Principles of Amputation
- save as much as possible
- eliminate neuromas- tumer of nerves — can cause a lot of pain if at distal limb
- provide residual limb that can tolerate prosthetic stress
- adequate circulation
- myoplasty: muscle to antagonist to create tension between muscle groups
- myodesis: surgeon attaches ligs and fascia to bone
- skin flaps
myoplasty VS myodesis
- myoplasty: tissue to tissue; padding for distal bone; (muscle to antagonist to create tension between muscle groups)
- myodesis: muscle to bone; (gastroc to bone in front of tibia)surgeon attaches ligs and fascia to bone (provides more stability)
Dysvascular - residual limb determination
Soft tissue, deformities, contractures, loss of sensation, delayed healing, diabetes
Trauma - Residual limb determination
Patient age, skin condition, bony condition, co morbidities, to salvage limb or not?
Tumor/Cancer - Residual limb determination
Lowest reoccurrence risk, amputation vs limb salvage
Congenital — Residual limb determination
Transverse vs longitudinal, complete vs incomplete, syndrome, surgical options/parent involvement, adjacent joints
They have time to think
Toe and Partial foot amputations
Lisfranc
Chopart
Syme’s
- Lisfranc: tarsometatarsal disarticulation
- Chopart: midtarsal disarticulation
- Syme’s: ankle disarticulation, talocrual joint (pt can do things w/o prosthetic!)
T or F: Transtibial needs adequate circulation, or else you’ll have to do transfemoral
TRUE
Hip disarticulation
Femur removed from acetabulum
Complications
- Hematoma
- Infection- skin and bone
- Neuroma
- Contracture - muscle length, joint
- Phantom Limb / Phantom Pain
Is residual limb cylindrical or conical?
Cylindrical
What do PTs work on with fresh amputees?
- muscle power
- ROM - no deformity
- well healed, mobile scar tissue free of infection
- muscles covering bones- muscular not flabby
- neuroma free
- TELL THEM TO TOUCH IT OVER DRESSING TO DESENSITIZE
CARE FOR RESIDUAL LIMB
- Keep clean and dry
- inspect and wash with mild antibacterial soak and warm water every note
- pat dry; do not soak or shave
- use non fragranced lotion
- observe and inspect
- sprinkler/ wraps should be changed daily and clean with mild soap. Do not wring or put in dryer, lay flat
Post Op Dressings
Rigid: immediate post op prosthesis (IPOP)
Semi Ridgid: air splints, casts, protectors (RRD)
Soft: ACE, Shrinker (liner)
ACE wraps benefits and disadvantages
Benefits: inexpensive; patient can perform, ease of skin checks, can modify for comfort
Disadvantages: some pts cant reach (transfemoral), difficult for pt to apply uniform pressure
Psychological Factors
- self concept - self view/body image
- chronic vs sudden - ptsd
Stages of Adjustment
Preop- possibly realized
Post Op - shock, depressed, unusual
Initiation of post op program - face reality
Reintegration- return to function ; varied attitudes
Types of Pain w/ Amputation
- residual limb pain
- phantom pain
- phantom limb sensation
Residual Limb Pain & Management
- pain in residual limb: stabbing, throbbing, pins and needles
- hypersensitivity over/around incision area
Management:
- gentle massage, tapping
- desensitization
- tens, modalities
- positioning
- assess post op dressing- compression
Phantom Limb Pain vs Sensation STATS
PAIN: 50% have shooting pain, severe cramping or burning
SENSATION: 80% have tingling, numbness, itching, pressure
Physiology behind Phantom Limb Pain
Higher incidence in ppl with chronic pain, PTSD, depression
Typically dissipates with time
