L5 Amputee Pre-Op Flashcards
Causes of Amputation
dysvascular
trauma
cancer
infection
congenital
Incidence/Prevalence of amputations
500 people/day undergo amputation
> 2 mil people live with limb loss
1 in 200 people with amputation will ahve 2nd amputation
are LE or UE amputations more commo?
LE
Dysvascular Amputations
accounts for 82% of all amputations
50% are due to diabetes
these patients are high risk for future complications and other amputations
When do dysvascular amputations occur?
- medical or revascularization options do not exist or have failed
- significant tissue loss has occurred
- complications from infection
Predisposing factor for LE amputation
peripheral neuropathy, common complication of diabetes
Other causes of amputation
- Trauma
- Tumors
- Congenital limb deficiency
- Infection
Factors affecting rehab prognosis for amputation
level of amputation
cognitive impairment
physical conditioning
social support
comorbidities
psychological factors
Components of Preventative Program
- risk identification
- prescription of appropriate footwear
- patient education and regular follow-up
Diabetic Risk Classifications
0 = no neuropathy
1 = with neuropathy, no deformity, no PVD
2 = with neuropathy and deformity or PVD
3 = history of ulceration or amputation
Risk Factors for development of diabetic foot ulcer
- previous foot ulcer
- peripheral neuropathy
- foot deformities
- partial foot amputation
- amputation of contralateral lower limb
- PVD
- visual impairments
- poor glycemic control
- smoking
Clinical signs of PVD
absent pulses
cold feet
dependent rubor
shiny skin
intermittent claudication
loss of hair on leg and foot
atrophy of subcutaneous fat
rest pain relieved with dependency
delayed capillary refill time
ischemic lesions
Sensory exam for high risk foot
sensory neuropathy does not affect all forms of sensation equally
foot ulcers development is correlated with increased vibratory perception and absence of protective sensation
Risk of ulceration associated with a vibratory threshold greater than
25 volts
risk increases as threshold rises
Protective sensation
ability to perceive 5.07 monofilament
smallest filament to which the patient responds at least 80% of the time
Footwear Assessment
should have shoes with extra depth or depth inlay
shoe should be measured in WB, at the widest part of forefoot
half in between end of longest toe and end of shoe
Avoid shoes
with narrow toes, shoes with thongs, high heeled shoes
Skin Care
wash feet daily
dry between toes
avoid lotion between toes
trim nails straight across
check water temp before bathing
ask PCP to check feet at each visit
Foot Self-Inspection
check feet daily
look for signs of injury
use mirror for bottom of feet
report any skin issues
do not walk barefoot
Patient education for pre-op
appearance of residual limb, length
residual limb pain
phantom pain/sensation
expected healing times
prognosis for prosthetic
surgical procedure
components of post op care
Disarticulation
amputation through a joint
Congenital limb deficiency
aim of amputation surgery in children is to produce a limb that is adequate for a prosthesis and that will remain adequate through the growth period and adulthood
Lisfranc amputation
tarsometatarsal disarticulation
Chopart amputation
midtarsal disarticulation
Syme amputation
disarticulation of talocrural joint
Transtibial amputation
below the knee amputation
typically has positive surgical outcomes
Longer residual limb
better functional outcomes
Knee Disarticulation
amputation through the knee joint
provides longer lever, maintains muscle length/MMT, preserves growth plates
but bulky prosthesis, poor cosmesis
Transfemoral amputation
above the knee amputation
better circulation increases healing
higher level of energy expenditure
preserving femoral length preserves muscle function
General Surgical Principles
level of amputation is based on viability of tissue healing
post op functioning is improved by longer limb length
must balance healing, clearance, and adequate soft tissue amount while preserving max limb length
Neuromas
occurs after PN has been transected
axons form an enlargement at distal end of nerve
if its large, superficial, or becomes squeezed against bone, it can cause pain
Myoplasty
attachment of anterior and posterior compartment muscles to each other over the end of the bone
Myodesis
anchoring of muscle to bone
Osteointegration
surgical implant into the bone of residual limb which attaches directly to prosthesis
possible in tibia, femur, humerus, radius, ulna
Potential candidates for osteointegration
short and/or wide RL
scarred RL
documented difficulty using socket
pain limiting functional use
Post amputation of healing
typically sutures are removed within 14-21 days after surgery
amputation due to vascular disease = 6-8 weeks
Delayed healing can be caused by
older age
diabetes
vascular insufficiency
infection
immunosuppression
traumatic damage
poor nutrition
