Final Exam - Limb Amputation Flashcards
what are some trauma related indications for amputation?
severely comminuted fractures, permanent peripheral nerve damage, severe soft tissue damage, & financial constraints
what are some neoplasia related indications for amputation?
primary bone tumors, large soft tissue tumors particularly of the distal limb
sometimes curative sometimes palliative
what is the normal weight distribution of dogs?
60% of weight on thoracic limbs & 40% on pelvic limbs
remaining thoracic limb bears 47% after amp & remaining pelvic limb bears 26% after amp
why is severe obesity a contraindication for amputation?
increasing BCS is associated with decreased quality of life after amputation
why is a thorough orthopedic & neuro exam necessary prior to amputation?
severe ortho or neuro disease in other limbs may decrease ability to recover from amputation
what should be done pre-op in a trauma patient before amputation?
chest rads - rule out diaphragmatic hernia, pulmonary contusions, pneumothorax etc
pocus - rule out hemoabdomen, urinary bladder rupture etc
what should be done pre-op in a cancer patient prior to amputation?
complete staging - chest rads, abdominal imaging, lymph node aspiration
make sure owner understands goal of the surgery - amputation for osteosarcoma isn’t curative
what should be included in your peri-operative plan for an amputation?
avoid IVC in contralateral limb
long procedure - perioperative cefazolin
be prepared for blood transfusion - pre-op aminocaproic acid in greyhounds
what 2 treatments can be used in an amputation surgery for reducing pain & minimizing blood loss?
intra-op nerve blocks with bupivacaine
electrosurgery
what are the rules for thoracic limb amputation?
whenever possible, cut through tendinous attachments near the scapula/humerus
do not need to cut intrinsic muscles - if cut, will add time, bleeding, and morbidity
avoid inadvertent entry into the thoracic cavity
what kind of thoracic limb amputation is recommended?
removal of entire limb including the scapula - elliptical shaped incision to allow for closure in a straight line
what is the first goal in thoracic limb amputation?
dissect scapula from trunk - incise SQ, incise omotransversarius, incise cranial trapezius continuing over dorsal scapula & place a towel clamp on the dorsal scapular spine & severe the rhomboideus close to the scapula & retract it laterally
after dissecting the scapula from the trunk, what is done next in a thoracic limb amputation?
elevate the serratus ventralis off the dorsomedial aspect of the scapula, inject brachial plexus with bupivacaine & transect
triple ligate axillary artery first then the vein leaving 2 sutures with the body
internally rotate the limb & transect latissimus dorsi - axillary lymph node & lateral thoracic vasculature lie underneath
after transecting the latissimus dorsi in a thoracic limb amputation, what is done next?
externally rotate limb, transect cleidobrachialis, ligate omocervical artery & vein, lift the limb & transect superficial & deep pectorals & carefully transect any remaining SQ
how is a thoracic limb amputation closed?
bring the pectorals to the scalenus, trapezius to latissimus, & use PDS in continuous or cruciate pattern
close SQ & skin closing as much dead space as possible
what are the 2 techniques used for pelvic limb amputation?
coxofemoral disarticulation & mid-femoral
where is the lateral incision placed in a pelvic limb amputation? what about the medial incision?
lateral - starts at flank fold & makes gentle curve
medial - similar to lateral but slightly more proximal
what vasculature is ligated first in a pelvic limb amputation?
femoral artery & vein - triple ligate
what muscles are transected first in a pelvic limb amputation?
sartorius, pectineus, adductor, & gracilis
then ligate medial circumflex femoral artery & vein
after the medial muscles/vasculature transection is finished in a pelvic limb amputation, what is done next?
palpate the hip joint & incise joint capsule with blade, disrupt the ligament of the femoral head
transect lateral side - tensor fascia lata at distal aspect fascia lata mid-femur, biceps femoris mid-femur, & caudal crural adductor mid-femur
then semitendinosus, semimembranosus, & remaining gluteal hip/rotator muscles to remove the limb
how is closure performed in a pelvic limb amputation?
bring biceps femoris to gracilis & semitendinosus
tensor fascia lata to sartorius or iliopsoas
close skin & SQ
what care is included in post-op amputation patients?
monitor post-op PCV if warranted
multi-modal analgesia - opioids & NSAIDs, but excess sedation may delay mobility
+/- bandage after thoracic limb amputation to provide compression
T/F: most dogs can ambulate the day after amputation surgery with minimal to no support
true
how long does it take for a dog to fully adapt to the amputation?
1 month
what are some complications associated with amputation?
incisional complications common - seromas especially on thoracic limb amputations, bruising, & infection
severe hemorrhage is rare but reported
what long term care is needed for amputation patients?
achieve & maintain lean body weight
protect the other limbs
