Introduction to Amputation Flashcards by Demond Fleming

facts about limb loss:
– individuals with ______ have a 30x greater risk for amputation
– up to ____% of individuals with diabetes and a lower limb amputation will undergo an amputation of the other lower limb within _____ years

– diabetes
– 55% ; 2-3

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these are ______ causes of amputations:
- dysvascular (PAD, PVD, diabetes, non-healing wounds)
- limb deficiencies/congenital
- infections
- tumors
- disease

non-traumatic

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these are ______ causes of amputations:
- high-energy trauma
- burns
- electrocution
- MVA

traumatic

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what are the most frequent causes of amputation in adults? (4)

PVD (most common from diabetes)
tumors
trauma
burns

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what are the most frequent causes of amputation in children? (4)

congenital limb deformities
tumors
trauma
infection

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what is the most likely cause if all 4 limbs are amputated?

systemic infection

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what is seen in utero and when with a limb deficiency/congenital amputation?

malformation of the limb bud ~28 days in utero

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what are causes of limb deficiencies/congenital amputations?

medications or toxins
viral infections rubella
diabetes
abortion attempts
unknown

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what are transverse limb deficiencies?

distal structures do not exist
– leaves a “cut off” appearance

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what are longitudinal limb deficiencies?

partial or total absence of a structure along the long axis of a segment
ex: may be missing a fibula in one leg, but has the tibia

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what are possible surgical interventions for a child without a fibula?

limb lengthening
amputation

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what are possible surgical interventions for a child without a tibia?

knee disarticulation
brown procedure - centralization of the fibula

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what are possible surgical interventions for a child with proximal femoral focal deficiency (PFFD)?

limb lengthening
foot amputation
rotationplasty

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in someone with a rotationplasty:
– DF = knee _____
– PF = knee _____

– flexion
– extension

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who is a rotationplasty most indicated for?

kids with cancer of the bone
proximal femoral focal deficiency

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what are goals of PT following a limb lengthening surgery?

maintain ROM above and below fixator
strengthen the limb
encourage weightbearing
increase endurance
restore function

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what types of tumors are amputations most used for to control the spread?

bone sarcomas (osteosarcoma)
soft tissue tumor
metastatic disease

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in someone with diabetes, what are 4 risk factors for amputation?

male
smoking
poor glycemic control
depression

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in someone with diabetes, what are 3 risk factors for re-amputation, re-ulceration, and mortality?

previous amputation
level of amputation
comorbidities

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what are two common infections that can lead to amputation?

osteomyelitis
sepsis

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osteomyelitis can be consequences of:

PVD or diabetes
RA
corticosteroid therapy
poor nutritional status
post-prosthetic implantation
trauma
fracture

what kind of burn injuries can lead to amputation?

electrical – direct contact with high-voltage electrical current
chemical
thermal – extreme heat, frostbite

what are 4 traumatic events that often lead to amputation?

MVA/MCA
non-union fractures
military conflicts
work accidents

what population is more likely to experience traumatic amputations?

young males

the level of amputation is dependent on:

vascular status of limb neuropathy infection necrosis malignancy bone and joint condition age function and rehab potential

in children: you generally want to preserve ____ and _______ if distal bone cannot be salvaged, amputate through _____ ___ and ____ may be needed to accommodate growth

-- proximal joints and length (growth plates) -- through the joint -- proximal osteotomies or external fixator techniques

what are common complications of traumatic amputation in adults?

infection slow wound healing DVT

what are common complications of traumatic amputation in children?

phantom limb pain residual limb pain terminal overgrowth

amputation surgical procedures: -- major nerves are cut ____ and retract into soft tissue to prevent ____ -- _____ of major arteries and veins. _____ for smaller vessels -- distal bone is ____ to help with prosthetic fit

-- high ; neuromas -- ligation ; cauterization -- beveled

muscle stabilization: -- posterior flap: -- myofascial closure = -- myoplasty = -- myodesis = -- tenodesis =

-- post. tissues have better blood supply than anterior. scar will be anterior -- muscle to skin -- muscle to muscle -- muscle to bone -- tendon to bone

residual limb shapes: -- common post-op due to swelling -- common in congenital amputations -- typically due to poor surgical technique -- common in traumatic amputations -- durable, well-vascularized, tolerates friction/pressure, ideal shape

-- bulbous -- conical -- dog ears -- complicated -- cylindrical

what should you examine in the residual limb?

length circumference integumentary vascular status sensation pain ROM strength

what kind of dressing is this describing: patient is at high risk for infection worn all day except bathing reapplied every 4-6 hours pt or caregiver can apply very common

soft post-op dressings -- shrinker -- elastic wrap

what kind of dressing is this describing: better edema control, but not the best impregnated bandage with a paste compound of zinc oxide, gelatin, glycerin, calamine typically 4" wide uncommon

semi-rigid post-op dressing

what kind of dressing is this describing: removable or non-removable pylon and foot component complications: infection, damage to wound, pressure or traction from pistoning

rigid post-op dressing

the CPG for lower and upper limb amputations advises: -- promote a ____ -- maximize patient's _____ _and ______ -- develop recommendations consistent with ______

-- patient-centered transdiciplinary approach -- functional independence and QoL -- evidence-based rehab methods

what are some goals of rehab for patients with amputations?

manage pain prevent injuries to sound limb improve/maintain physical health independent and safe in walking and ADLs participate in community maintain QOL healthy body image find satisfaction with independence improve independence with and without prosthesis

phases of rehab for amputees: -- pre surgical -- 1-2 weeks -- 2-8 weeks -- 8 weeks - 18 months -- throughout lifespan

-- before surgery -- acute post-surgical -- pre-prosthetic training -- prosthetic training -- lifelong care

around what week at the earliest do post-op amputees start prosthetic training? a) 4 weeks b) 8 weeks c) 12 weeks d) the earlier the better

b) 8 weeks (8 weeks to 18 months)

according to the CPG, what should rehab providers be provided with?

an algorithm of appropriate rehab interventions to improve patient outcomes and reduce practice variation

according to the CPG, what should primary care providers be provided with?

an algorithm to assist with the referral process

during all phases of amputation rehab, it is recommended that providers consider ____ and self-identified ____ in developing individualized treatment plans

birth sex ; gender identify

during all phases of amputation rehab: -- provide: -- measure: -- offer: -- assess:

-- patient education -- intensity of pain and interference with functioning -- multi-modal, transdisciplinary approach to pain management including transition to non-narcotics AND peer support interventions as early as feasible -- behavioral health and psychosocial functioning

what is the PROMIS?

patient-reported outcome measurement information system -- evaluates and monitors physical, mental, and social health

what are causes of residual limb pain?

expected from surgical trauma poor prosthetic fit bruising or chafing poor perfusion/ischemia heterotopic ossification neuroma

what are some treatment options for residual limb pain?

- oral meds: antidepressants, tricyclics, antiepileptics, opioids - IV: ketamine, opioids - nerve block - physical therapy - prosthetic mods

what does physical therapy focus on to improve residual limb pain?

exercise & modalities (massage, TENS) desensitization exercises

how often does phantom limb pain occur?

in 80% of patients with amputations

phantom limb pain: -- (episodic/constant) -- lasts: -- mechanisms:

-- episodic -- seconds to days; or continuous -- unclear -- abnormal regeneration of primary afferent neurons, central sensitization, chronic pre-amp pain

how do you treat phantom limb pain?

massage, ultrasound, ice, TENS non-narcotic analgesics biofeedback, guided imagery psychotherapy nerve blocks mirror therapy -- apply these things to the good leg

in patients with traumatic lower limb amputations: -- ______% develop an overuse MSK injury during 1st year -- those with ____ amputation were 2x more likely to develop upper or lower limb MSK injury -- those with _____ amputations were >2x more likely to develop lumbar spine injury and 4x more likely to develop an upper limb injury

-- 59-68% -- unilateral -- bilateral

in patients with traumatic upper limb amputations: -- ______ develop an overuse MSk injury within 1st year

47-58%