LE Amputation Etiology Flashcards
It is estimated that > ________ individuals are living with the loss of 1 or more limbs in the US. Rates increase dramatically with _____.
- 2 million
- age
82% of amputations are due to _________.
-Secondary to complications of _____, _____.
- vascular disease
- diabetes, PAD
What is important in reducing the incidence of amputations?
- Early patient education
- Proper foot care
Majority of LE amputations are due to __________ while a majority of UE amputations are due to _________.
- vascular disease
- trauma
Why are the rates of amputation decreasing among diabetics, trauma patients, and cancer patients, despite an overall increase in these conditions?
We are doing a better job of educating patients and managing diabetes.
Do comorbidities increase the risk of amputations?
Yes
Are males or females more likely to have dysvascular and trauma related amputations?
Males
Is there racial disparity in regards to amputations?
Yes, African Americans, Hispanic American, and Native Americans are more likely.
Trauma and cancer related amputations are on the _______.
decline
What are the top 4 causes of amputation (in order)?
- Diabetes and PAD (Dysvascular Disease)
- Trauma
- Cancer
- Congenital Deficiencies
____________ is the most common risk factor for ulcer development in diabetes.
Peripheral Neuropathy
Describe the cascade of symptoms of peripheral neuropathy in diabetics that leads to amputation.
- Elevated Blood Sugars damages blood vessels and nerves leading to
- Loss of Protective Sensation resulting in blister or minor injury leading to a
- Ulceration that is non-healing causing
- Amputation
What are the 3 clinical signs of peripheral neuropathy?
- Deficits in sensation
- Motor impairments
- Autonomic dysfunction (different color, hair loss)
All these lead to a vulnerability of the foot to high-pressure and repetitive low-pressure traumas.
What are some other diabetic complications that lead to amputation other than peripheral neuropathy?
- ) Severe ischemic pain
- ) Absent pulses
- ) Local necrosis
- ) Osteomyelitis (bone infection)
- ) Systemic toxicity
- ) Acute embolism
- ) DVT
What are the 2 classic symptoms of PAD?
- ) Intermittent claudication (leg pain brought about by activity)
- ) Loss of one or more LE pulses
What are the 3 risk factors of PAD?
- ) Poorly managed HTN
- ) High cholesterol and triglyceride levels
- ) History of tobacco use
The 3 risk factors for PAD are also risk factors for _________ and _________.
- Stroke
- Cardiovascular Disease
How do we prevent limb loss in patients with diabetes?
- Foot screens (protective sensation, skin temp, distal pulses, visual observation)
- Patient recommendations (daily foot checks)
Do all diabetic patients receive foot screens?
ALL patients
What is included in a foot screen?
- Protective sensation with 10g monofilament
- Skin Temp with palpations for distal pulses (looking for elevated)
- Distal Pulses (arteriosclerosis obliterans)
- Visual Observation (nail shape and color, deformities, swelling, callus formation)
Protective sensation portion of the foot screen is done with a __g monofilament.
10g
Why are we looking for elevated temperatures when doing a foot screen?
Elevated temps show signs of inflammatory response.
When educating patient on performing daily foot checks, what do we tell them to look for?
- Increased temp
- Check pulse
- Nail color change
- Open wounds
What do we do if our patients cant see their feet either from obesity or lack of mobility?
- Teach them to use a mirror
- Teach caregiver
Bottom Line:
- ___________ and _____ are the major predisposing risk factors for LE amputation in individuals with DM.
- Amputations in this population are associated with:
- Significant __________
- Significant _________ limitations
- Future disability
- Another LE amputation
- __________ (33% in 1 year)
- Increased health care costs
-Peripheral neuropathy and PAD
- morbidity
- functional
- mortality
Why would an amputation due to diabetes predispose an individual for a second amputation or revision?
- Can be contralateral limb but often times the same limb
- Surgical incisions don’t have good blood flow or blood getting there isn’t oxygenated leading to a 2nd amputation.
What is the 2nd leading cause for amputations behind Diabetes and PAD?
Trauma
What are the leading causes of trauma amputation?
- MVA
- Farming accidents
- Power tools
- Firearms
- Burns and electrocutions
What is the typical patient profile for an individual who suffers limb loss from trauma?
- MEN
- 20-29 yo
- Primary cause of UE amp.
There tends to be an increased __________ impact with trauma amputations.
psychological
What are some challenges of traumatic amputations?
- Limb length, shape (for prosthetics)
- Partial vs. full amputation
- Multiple surgeons
- Tissue viability and loss
- Pain
- Other injuries
What is the 3rd leading cause for amputations behind trauma?
Cancer
Cancer amputation is a result of _________ at or near epiphysis of long bones such as distal ______, proximal _______, proximal ________.
- osteosarcoma
- distal femur, proximal tibia, proximal humerus
What is the typical patient profile for an individual who suffers limb loss from cancer?
- Male
- Late childhood through early adulthood (~12-24)
What are some other factors of cancer amputation?
- chemo and radiation
- surgery
What do we look for in patients with osteosarcoma?
- Pain with weightbearing
- Hx of worsening, deep local pain
- Fractures (often first sign)
What is the 4th leading cause for amputations behind cancer?
Congenital Deficiency
Surgical intervention is ____ common with congenital deficiency.
less
What are challenges for pediatric amputees?
- Rapid growth
- Cosmesis
- Provide for function
Main Takeaways:
- ________ disease is the leading cause of LE amputation (diabetic complications).
- ______ more affected than ________.
- Lower limb __x more likely that upper limb
- Traumatic amputations are more likely to occur in men, __-__ yo.
- _______ is third leading cause.
- Congenital deformity/deficiency is less than _% of all amputations.
- Dysvascular
- Males, females
- 11x
- 20-29 yo
- Cancer
- 1%
