Lecture 15 - Amputations Flashcards
What are common causes of limb loss
Residual limb
Remaining part of limb after an amputation
Remaining Limb
Unaffected leg
Amputation
Loss or removal of a portion or entire limb by dividing through one or more bones
Disarticulation
Removal of a limb between joint surfaces
Partial Toe (Amputation)
Ray Resection (Amputation)
Trans metatarsal (Amputation)
Ankle Disarticulation (Symes -> Amputation)
Transtibial (BKA -> Amputation)
Transfemoral (AKA -> Amputation)
Hip Disarticulation (Amputation)
Hemipelvectomy (Amputation)
Hemicorporectomy (Amputation)
What are the 2 most common LE amputations?
Circled in red
Compare transtibial (BKA) and Syme’s (Ankle disarticulation) amputation in terms of lever length, shape, healing rate, and end weightbearing
Note: Cylindrical is better for prosthesis
Name some UE amputation
What is a forequarter (interscapulothoracic) amputation
Amputation that is very rarely performed (only malignancies) that takes the entire UE including scapula and clavicle
Osseointegration
Metal implant that attaches to femur that prevents rubbing and irritation on butt and groin area = much more comfortable and can feel the ground and vibrations
Rotationplasty
Cut off bad part of leg (most of it) and rotate foot/ankle and reattach to upper thigh, then can attach prosthetic to foot and gives them the benefit of it being easier for a prosthetic and for them to keep their sensation in their foot
Open amputation
Wound left open to allow for clearance of infection
NOTE: Black dressing = put over open wound hooked up with hose to portable vacuum to stimulate granulate tissue to help with healing
Closed amputation
Skin flaps are closed
What factors determine the level of amputation
- Patient history
- surgeons clinical exam
- Surgeon’s knowledge/preference
- Interoperative tissue condition
- Tissue viability
- Infection
- Function
What are 3 surgical goals of amputation
What are 4 methods of muscle closure after amputation
What happens to the skin after amputation
What happens to the bone after amputation
What happens to the nerves after amputation
What happens to the blood vessels after amputation
What is the course in hospital after minor amputation
Is it important to maintain heel weight bearing status and why or why not?
Yes for adequate knee and ankle ROM
Name 3 options to maintain heel weight bearing status
What sound dont you want to here from a darco boot?
-Clicking sound means coming forward on toes which you don’t want to do
What are the 3 phases of post-op care for BKA and AKA
What are post-surgical goals for BKA and AKA (8)
What are causes of edema following amputation?
What are complications of edema following amputation
What are methods to control edema
What are types of dressings to use after amputation (5)
Soft dressings, pros, and cons
Semi-rigid dressings, pros, and cons
Rigid dressings, pros, and cons
What are 3 methods of compression and limb shaping following amputation
How should tubigrip be applied for BKA
Below knee amputation up to mid thigh -> need it snug up to bottom and not to pucker
How should tubigrip be applied for AKA
How should tensor wrap be applied for BKA
Make sure pressure is consistent throughout
How should tensor wrap be applied for AKA
Make sure pressure is consistent throughout
What are removable rigid dressings, and there pros and cons
What is an immediate post-op prosthesis and its pros and cons
What are key focuses of positioning following amputation
What are common contracture for above knee amputations (AKA)
What are common contracture for below knee amputations (BKA)
What are the implications of contractures following amputations
Why do contractures occur following amputation
What are methods to prevent contractures
Should you avoid putting a pillow under the limb of an amputation
Yes, it Encourages knee and hip flexion -> do not want that as we want the leg to be flat and straight
What are some ROM and strengthening exercises focusses for amputation
-Residual limb just doing gentle ROM no strength training at this type
What is the cause of residual limb pain and some methods to treat it
Should we use cryotherapy for the vascular amputation population?
NO -> Neuropathy = cannot feel the cryotherapy and also we want to encourage blood flow to the area to enhance healing so adding ice inhibits blood flow and therefore the healing process
Phantom sensation
feeling or tickling after limb is removed = normal (body is adjusting to surgery)
Phantom pain
burning sharp shooting pain (again body is adjusting to surgery = less common though)
What are typical reported feelings for phantom lib sensations and some consequences
What are some solutions to resolve phantom limb sensation?
What are different types of mobility for amputees
What happens to the center of mass following an amputation
Also because they loss mass from amputation (look at image in first part)
How does a centre of mass shift impact bed mobility, transfers, balance, ambulation, and safety?
Methods for bed mobility and supine to sit for amputees
Methods for balance training for amputees
Methods for transfer training for amputees
What is the importance of manual wheelchair propulsion
When is ambulation/stair training performed for amputees
Should hopping be performed by amputees and what would some potential complications be and methods to reduce fall risk?
It depends
What is the course in a hospital following a major amputation
