Introduction to Amputation Flashcards
What is an amputation?
Surgical removal of a body part, partial, or full extremity, due to disease, trauma or injury
What is a prosthesis?
replacement of all or part of the extremity removed
Which are more common LE or UE amputations?
LE > UE
What are predisposing factors for amputation?
- Diabetes
- Hypertension
- Dyslipidemia
Name some non-traumatic cause of amputation
- Dysvascular (PVD)
- Diabetes
- Limb deficiencies
- Congenital
- Infections
- Tumors
- Disease
Name some traumatic causes of amputation
- High energy trauma
- Burns
- electrocution
- Motor vehicle accident
What are some reasons that adults may need an amputation?
- Diabetes
- Peripheral vascular disease
- Tumors
- Trauma
- Burns
What are some reasons that children may need amputations?
- Congenital limb deformities
- Tumors
- Trauma
- Infection
What are some ways that limb preservation or limb salvage may occur?
- Re vascularization
- Bone grafting
- Local/free flap coverage
- Repair of major nerve
- Compartment syndrome
- Skeletal stabilization
What are the 3 factors that determine the level of amputation?
- Ability to heal successfully at the incision based on adequate circulation
- Removal of all non viable tissues, structures, especially in presence of infection
- Achieve long term functional residual limb, restore patient to some level of activity without pain
What is the principles and goals of surgeons when performing an amputation?
- Maintain the most adequate length of residual limb
- Protection of severed neuromuscular structures
- Muscle stabilization
- Non-tender/ non adherent scar/skin
- Functional shape of residual limb
Describe the general surgical technique for amputation
- Major nerve are cut high & retract into soft tissue to prevent neuromas
- Ligation (tied or closed off) of major arteries & veins
- Cauterization for smaller vessels
- Distal bone is beveled to help with prosthetic fit
The scar will (anterior or posterior) and skin flap will be (anterior or posterior)
- Scar will be anterior
- Skin flap will be posterior (posterior flap) because tissues typically have better blood supply
What is a myofascial closure?
muscle to skin
What is a myoplasty?
Muscle to muscle
What is a myodesis?
Muscle to bone
What is tenodesis?
Tendon to bone
What is a neuroma?
- Complication following amputation
- Bundle of nerve ending that group together & produce pain due to scar tissue, pressure from the prosthesis or tension on the residual limb
What is the physiological impact following amputation?
- Denial, grief, anxiety, depression or suicidal feelings
- Intensity of thoughts may be elevated in patients following emergency amputation since they had insufficient time to mentally prepare for loss
Why can wound infections be a complication following amputation?
Due to surgery or future wounds
Why can contractures form following amputation?
- Failure to initiate full ROM early in post-op phase and poor positioning significantly increased risk of contracture
- Joint immediately proximal to amputation is most susceptible
What are the most common type of contractures?
- Transtibial knee flexion
- Transfemoral hip flexion & abduction
What is a DVT?
Blood clot that forms in a vein with potential to dislodge as an embolism
What is phantom limb?
- Painless sensation where the patient feels that the limb is present
- Commonly immediately after amputation & will usually subside with desensitization & prosthetic use, however it may continue for extended periods of time for some patients
What is phantom pain?
- Patients perception of some form of painful stimuli as it related to the residual limb
- Continuous or intermittent, local or general, short term or permanent
What are some treatment options for phantom pain?
- TENS
- Ultrasounds
- Icing
- Mirror therapy
- relaxation techniques
- Desensitization techniques
- Prosthetic use
Why is hypersensitivity an issue following amputation?
- Can impede or even prevent the appropriate fit & functional use of prosthesis
What are treatment options to combat hypersensitivity after an amputation?
- Specific de-sensitization techniques & early fitting of a temporary prosthesis are key components
- Weight bearing, massage, tapping, & residual limb wrappings are all commonly utilized
What are some risk factors for amputation?
- Male
- Smoking
- Poor glycemic control
- Depression
What are some risk factors for re-amputation, re-ulceration, mortality?
- Previous amputation
- Level of amputation
- Comorbidites
Name some reasons for amputations
- Diabetes
- PVD
- Tumors
- Infections
- Burn injuries
- Trauma
What is a PVD?
Any abnormal condition affecting blood vessels peripheral to the heart
What can a PVD be caused by and lead to?
- Caused by: embolism, thrombosis, trauma, vasospasm, inflammation, arteriosclerosis
- Leads to: Deficits in arterial, venous, lymphatic systems
How do electrical burns occur?
Direct contact with high-voltage electrical current
How can thermal burns occur?
- Extreme heat
- Frostbite
Name some examples of trauma that can cause amputations
- MVA
- non-union fractures
- Military conflicts
- Work accidents
Why has the number of wartime amputations decreased?
- Recent wars have lowest fatality rates
- Improvement in body armor
- Tourniquet use
- Surgeons deployed
What is limb deficiencies?
- Congenital amputation
- Partial or total absence of a structure along the long axis of a segment
How can limb deficiencies be treated?
- Possible surgical intervention (Ilizarov-Limb lengthening procedure)
- amputation
What are the goals of PT with limb deficiencies?
- Maintain ROM above & below fixation
- Strengthen the limb
- Encourage weight bearing
- Increase endurance
- Restore function
What are the general principles of amputation in children?
- Preserve proximal joints (hip, knee)
- Preserve length (growth plates)
- Amputate through the joint if vital bone can not be salvaged
- Proximal osteotomies or external fixation techniques may be needed to accommodate growth
What is the level of amputation dependent on?
- Vascular status of limb
- Neuropathy
- Infection
- Necrosis
- Malignancy
- Bone & joint condition
- Age
- Function & rehab potential
What is a tarsometatarsal (lisfranc) amputation?
- Removal of metatarsals
- Preserved the dorsiflexors & plantar flexors
What is a transverse tarsal (chopart) amputation?
- Amputation through the talonavicular & calcaneocuboid joints
- Preserves the plantar flexors but sacrifices the dorsiflexors often resulting in equines contracture
What is symes amputation?
Removal of the foot & ankle joint with removal of malleoli
What is a transtibial amputation?
Removal of the lower extremity below the knee joint
What is the knee disarticulation amputation?
Removal of the lower extremity through the knee joint
What is a transfemoral amputation?
Removal of the lower extremity above the knee joint
What is hip disarticulation amputation?
Surgical removal of the lower extremity from the pelvis
What is a hemipelvectomy?
Removal of 1/2 of the pelvis & lower extremity
What is a hemicorporectomy?
Removal of the pelvis & both lower extremities
What is digital amputation?
Removal of a digit at either the metacarpophalangeal, proximal interphalangeal, or distal interphalangeal level
What is a partial hand amputation?
Removal of a portion of the hand and the digits at either the trans carpal, transmetacarpal, or transphalangeal level
What is wrist disarticulation amputation?
Removal of the hand through the wrist joint
What is a transradial amputation?
Removal of the upper extremity distal to the elbow joint
What is an elbow disarticulation amputation?
Removal of the upper extremity through elbow joint
What is a transhumeral amputation?
Removal of the upper extremity proximal to the elbow joint
What is a shoulder disarticulation amputation?
Removal of the upper extremity through the shoulder
What is a forequarter amputation?
Remove of the upper extremity including the shoulder girdle
Describe K0 level
Patient is not able or does not have the potential to ambulate or transfer safely with or without the assistance and a prosthesis does not enhance mobility
Describe K1 Level
- Patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces a fixed cadence
- Household ambulator
Describe K2 Level
- Patient has the ability potential for ambulation to transverse low-level environmental barriers such as curbs, stairs, uneven terrain
- Community ambulator
Describe K3 Level
- Patient has the ability or potential for ambulation with variable cadence
- Community ambulator with activity level beyond simple locomotion
Describe K4 Level
- Patient has the ability or potential for ambulation beyond basic ambulation exhibiting high impact, stress, or energy levels
- Typical child, active adult or athlete
What is the purpose of the L Test?
Assess function & dynamic balance
What is the MCID of the L Test?
4.5 seconds
What is the AMPnoPRO used for?
Greatest potential to asset in prosthetic prescription
What is the MDC for AMP test?
3.4 points
What is included in the Prosthesis Evaluation Questionnaire (PEQ)?
Most question use a VAS scale to assess satisfaction, well-being, frustration, pain & residual limb health
What does the Orthotics Prosthetics User Survey consist of?
Functional status, quality of life & satisfaction modules
What is the Trinity Amputation and Prosthesis Experience Scales - Revised examine?
Multi-dimensional instrument designed to examine the psychosocial process of amputation & prosthesis
