L5 Amputee Pre-Op

Question 1

Causes of Amputation

Answer 1

dysvascular
trauma
cancer
infection
congenital

Question 2

Incidence/Prevalence of amputations

Answer 2

500 people/day undergo amputation

> 2 mil people live with limb loss

1 in 200 people with amputation will ahve 2nd amputation

Question 3

are LE or UE amputations more commo?

Answer 3

LE

Question 4

Dysvascular Amputations

Answer 4

accounts for 82% of all amputations
50% are due to diabetes

these patients are high risk for future complications and other amputations

Question 5

When do dysvascular amputations occur?

Answer 5

1. medical or revascularization options do not exist or have failed
2. significant tissue loss has occurred
3. complications from infection

Question 6

Predisposing factor for LE amputation

Answer 6

peripheral neuropathy, common complication of diabetes

Question 7

Other causes of amputation

Answer 7

1. Trauma
2. Tumors
3. Congenital limb deficiency
4. Infection

Question 8

Factors affecting rehab prognosis for amputation

Answer 8

level of amputation
cognitive impairment
physical conditioning
social support
comorbidities
psychological factors

Question 9

Components of Preventative Program

Answer 9

1. risk identification
2. prescription of appropriate footwear
3. patient education and regular follow-up

Question 10

Diabetic Risk Classifications

Answer 10

0 = no neuropathy
1 = with neuropathy, no deformity, no PVD
2 = with neuropathy and deformity or PVD
3 = history of ulceration or amputation

Question 11

Risk Factors for development of diabetic foot ulcer

Answer 11

1. previous foot ulcer
2. peripheral neuropathy
3. foot deformities
4. partial foot amputation
5. amputation of contralateral lower limb
6. PVD
7. visual impairments
8. poor glycemic control
9. smoking

Question 12

Clinical signs of PVD

Answer 12

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

Question 13

Sensory exam for high risk foot

Answer 13

sensory neuropathy does not affect all forms of sensation equally

foot ulcers development is correlated with increased vibratory perception and absence of protective sensation

Question 14

Risk of ulceration associated with a vibratory threshold greater than

Answer 14

25 volts
risk increases as threshold rises

Question 15

Protective sensation

Answer 15

ability to perceive 5.07 monofilament

smallest filament to which the patient responds at least 80% of the time

Question 16

Footwear Assessment

Answer 16

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

Question 17

Avoid shoes

Answer 17

with narrow toes, shoes with thongs, high heeled shoes

Question 18

Skin Care

Answer 18

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

Question 19

Foot Self-Inspection

Answer 19

check feet daily
look for signs of injury
use mirror for bottom of feet
report any skin issues
do not walk barefoot

Question 20

Patient education for pre-op

Answer 20

appearance of residual limb, length
residual limb pain
phantom pain/sensation
expected healing times
prognosis for prosthetic
surgical procedure
components of post op care

Question 21

Disarticulation

Answer 21

amputation through a joint

Question 22

Congenital limb deficiency

Answer 22

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

Question 23

Lisfranc amputation

Answer 23

tarsometatarsal disarticulation

Question 24

Chopart amputation

Answer 24

midtarsal disarticulation

Question 25

Syme amputation

Answer 25

disarticulation of talocrural joint

Question 26

Transtibial amputation

Answer 26

below the knee amputation

typically has positive surgical outcomes

Question 27

Longer residual limb

Answer 27

better functional outcomes

Question 28

Knee Disarticulation

Answer 28

amputation through the knee joint

provides longer lever, maintains muscle length/MMT, preserves growth plates

but bulky prosthesis, poor cosmesis

Question 29

Transfemoral amputation

Answer 29

above the knee amputation
better circulation increases healing
higher level of energy expenditure

preserving femoral length preserves muscle function

Question 30

General Surgical Principles

Answer 30

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

Question 31

Neuromas

Answer 31

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

Question 32

Myoplasty

Answer 32

attachment of anterior and posterior compartment muscles to each other over the end of the bone

Question 33

Myodesis

Answer 33

anchoring of muscle to bone

Question 34

Osteointegration

Answer 34

surgical implant into the bone of residual limb which attaches directly to prosthesis

possible in tibia, femur, humerus, radius, ulna

Question 35

Potential candidates for osteointegration

Answer 35

short and/or wide RL
scarred RL
documented difficulty using socket
pain limiting functional use

Question 36

Post amputation of healing

Answer 36

typically sutures are removed within 14-21 days after surgery

amputation due to vascular disease = 6-8 weeks

Question 37

Delayed healing can be caused by

Answer 37

older age
diabetes
vascular insufficiency
infection
immunosuppression
traumatic damage
poor nutrition