Final Exam - Limb Amputation

Question 1

what are some trauma related indications for amputation?

Answer 1

severely comminuted fractures, permanent peripheral nerve damage, severe soft tissue damage, & financial constraints

Question 2

what are some neoplasia related indications for amputation?

Answer 2

primary bone tumors, large soft tissue tumors particularly of the distal limb

sometimes curative sometimes palliative

Question 3

what is the normal weight distribution of dogs?

Answer 3

60% of weight on thoracic limbs & 40% on pelvic limbs

remaining thoracic limb bears 47% after amp & remaining pelvic limb bears 26% after amp

Question 4

why is severe obesity a contraindication for amputation?

Answer 4

increasing BCS is associated with decreased quality of life after amputation

Question 5

why is a thorough orthopedic & neuro exam necessary prior to amputation?

Answer 5

severe ortho or neuro disease in other limbs may decrease ability to recover from amputation

Question 6

what should be done pre-op in a trauma patient before amputation?

Answer 6

chest rads - rule out diaphragmatic hernia, pulmonary contusions, pneumothorax etc

pocus - rule out hemoabdomen, urinary bladder rupture etc

Question 7

what should be done pre-op in a cancer patient prior to amputation?

Answer 7

complete staging - chest rads, abdominal imaging, lymph node aspiration

make sure owner understands goal of the surgery - amputation for osteosarcoma isn’t curative

Question 8

what should be included in your peri-operative plan for an amputation?

Answer 8

avoid IVC in contralateral limb

long procedure - perioperative cefazolin

be prepared for blood transfusion - pre-op aminocaproic acid in greyhounds

Question 9

what 2 treatments can be used in an amputation surgery for reducing pain & minimizing blood loss?

Answer 9

intra-op nerve blocks with bupivacaine

electrosurgery

Question 10

what are the rules for thoracic limb amputation?

Answer 10

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

Question 11

what kind of thoracic limb amputation is recommended?

Answer 11

removal of entire limb including the scapula - elliptical shaped incision to allow for closure in a straight line

Question 12

what is the first goal in thoracic limb amputation?

Answer 12

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

Question 13

after dissecting the scapula from the trunk, what is done next in a thoracic limb amputation?

Answer 13

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

Question 14

after transecting the latissimus dorsi in a thoracic limb amputation, what is done next?

Answer 14

externally rotate limb, transect cleidobrachialis, ligate omocervical artery & vein, lift the limb & transect superficial & deep pectorals & carefully transect any remaining SQ

Question 15

how is a thoracic limb amputation closed?

Answer 15

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

Question 16

what are the 2 techniques used for pelvic limb amputation?

Answer 16

coxofemoral disarticulation & mid-femoral

Question 17

where is the lateral incision placed in a pelvic limb amputation? what about the medial incision?

Answer 17

lateral - starts at flank fold & makes gentle curve

medial - similar to lateral but slightly more proximal

Question 18

what vasculature is ligated first in a pelvic limb amputation?

Answer 18

femoral artery & vein - triple ligate

Question 19

what muscles are transected first in a pelvic limb amputation?

Answer 19

sartorius, pectineus, adductor, & gracilis

then ligate medial circumflex femoral artery & vein

Question 20

after the medial muscles/vasculature transection is finished in a pelvic limb amputation, what is done next?

Answer 20

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

Question 21

how is closure performed in a pelvic limb amputation?

Answer 21

bring biceps femoris to gracilis & semitendinosus

tensor fascia lata to sartorius or iliopsoas

close skin & SQ

Question 22

what care is included in post-op amputation patients?

Answer 22

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

Question 23

T/F: most dogs can ambulate the day after amputation surgery with minimal to no support

Answer 23

true

Question 24

how long does it take for a dog to fully adapt to the amputation?

Answer 24

1 month

Question 25

what are some complications associated with amputation?

Answer 25

incisional complications common - seromas especially on thoracic limb amputations, bruising, & infection

severe hemorrhage is rare but reported

Question 26

what long term care is needed for amputation patients?

Answer 26

achieve & maintain lean body weight

protect the other limbs