Lesson 1 Flashcards
1
Q
Indications for Amputation
A
Peripheral vascular disease Diabetic limb disease necrotising fascitis trauma infection tumors nerve injury congenital anomalies
2
Q
extended foot plate:
A
extended carbon fiber foot plate
includes incorporation of a steel shank into the sole of shoe to allownormal toe off ambulation
3
Q
What does spring steel shank do?
A
reproduces the action of longitudinal arch offoot during ambulation
4
Q
toe filler:
A
custom molded foam pad or lamb’s wool can fill the distal empty toeportion of the shoe
rigid rocker bottom sole
5
Q
What does a Chopart amputation remove and save?
A
remove: forefoot and midfoot
save: talus and calcaneus
6
Q
Benefit’s of Syme’s amputation:
A
Distal Weight Bearing Longer limb=less energy loss Can ambulate without prosthesis Proprioception Preservation of distal growth plate in children
7
Q
Negative of Syme’s amputation:
A
Wound healing
Compliance
Heel pad instability
8
Q
Tibial length not feasible for fitting:
A
3.5 inches
9
Q
Myoplasty suturing
A
Opposing Muscle sutured together
Muscle to soft tissue
Soft tissue to soft tissue
Transtibial amputation preferred
10
Q
Main advantage of thru knee amputation:
A
creation of endbearing stump and preservation of distal femoral physes
long active lever arm
11
Q
Suction socket:
A
provide suspension by means of negative pressure vacuuming.
achieved by forcing air out of the socket through a one-way valve when donning and using the prosthesis
12
Q
Myodesis:
A
suturing of muscle bone
13
Q
Myoplasty:
A
muscle is sutured to muscle and then placed over the end of the bone before closing the wound
patients with poor vascular health, the myoplasty technique is preferred
14
Q
PFFD’s: Proximal Focal Femoral Deficits
A
Congenital defect of the proximal femur
15
Q
Congenital defect of the proximal femur
A
absent hip
femoral neck pseudoarthrosis
absent femur
shortened femur
16
Q
transradial optimum level:
A
junction prox 2/3 and distal 1/3
17
Q
Transradial shortest level:
A
3cm below biceps insertion
18
Q
Transhumeral optimum level:
A
middle third
19
Q
Transhumeral shortest level
A
4cm below axillary fold
20
Q
Transfemoral optimum level
A
middle third
21
Q
Transfemoral shortest level
A
8cm below pubic ramus
22
Q
Transtibial optimum level
A
8cm for every metre of height(12cm
23
Q
transtibial shortest level
A
7.5cm below knee joint
24
Q
Transradial longest level
A
5cm above wrist joint
25
Transhumeral longest level
10cm above olecranon
26
Transfemoral longest level
15cm above knee joint
27
Krukenberg procedure
Separate radial and ulna rays distally
| forming radial and ulna pincers capable of strong prehension and excellent manipulative ability
28
What are the three parts of the peripheral vascular system?
Arterial System
Venous System
Lymphatic System
29
Function of arterial system:
Carry oxygenated blood to the capillaries of the body organs.
30
Tunica Intima
endothelium, CT, basement membrane
31
Tunica Media
smooth muscle. The strength of the artery
32
Tunica Adventitia
elastic and collagenous fibers
33
Where is blood pressure greatest?
Muscular smaller arteries expand only slightly regardless of the pressure.
34
Lymphatics
facilitates movement of fluid between bloodstream (veins and arteries) and interstitium to remove wastes, extra fluid and proteins
35
Peripheral vasculature:
arterial
venous
lymphatics
36
Arteriosclerosis
hardening of arterial walls
37
Atherosclerosis
common form of arteriosclerosis, often plaque deposits on endothelial lining
38
Arteriosclerosis obliterans
atherosclerosis manifested peripherally (usually LE)
39
Thromboangiitis obliterans (Buerger’s disease)-
Specific arterial disease with tissue ischemia in young men who smoke
40
Raynaud’s disease-
disease which causes constriction in the small arteries
41
Risk factors for arterial disease
```
Smoking
Cardiac disease (and its related risk factors)
Diabetes
High blood pressure
Kidney disease
```
42
Function of lymphatic system:
Transport interstitial fluids back to blood
Transport absorbed fat from small intestine
Lymphocytes provide immunological defenses
43
Tunics of lymphatic system:
Three layers, similar to veins
Close-ended tubes
Inner layer forming valves which prevent backflow of lymph.
44
Movement of lymph
Peristaltic motion and valvular closure
45
PVD Signs and Symptoms (arterial)
```
sharp pain relieved by rest
chronic cramping w/exercises, heaviness, leg fatigue
diminished or absent pulse
absent edema
cool or cold skin
dry, shiny, scaling, thin skin
hairless
cyanotic
```
46
PVD Signs and Symptoms (venous)
```
aching, deep muscle pain
relieved by activity or elevation
intermittent claudication
pulses present
edema increases at end of day
warm skin, thick, toughened
dark pigmentation
varicose veins/ulcers
```
47
Aterial Occlusive
| 4 major risk factors
Smoking
Diabetes
High-fat diet
Hypertension
48
Symptoms – The Five P’s
```
Pain
Pallor
Paralysis
Parasthesia
Pulselessness
```
49
Peripheral arterial disease (atherosclerosis)
| Pathology:
Slow progression
Initial injury to vessel from HTN or trauma
Fatty deposits line artery wall at injury site.
Leads to vessel narrowing and blockage followed by ischemia and tissue necrosis
50
Symptoms of Chronic Arterial Disease
intermittent claudication
diminished/absent pulses
trophic changes
wound formation
51
Buerger’s Disease
Similar to Acute Arterial Occlusive Disease but it occurs predominantly in young men (under age 40) who are heavy smokers
Inflammatory process in the small vessels of the feet and hands that is directly related to nicotine use
Leads to thrombus formation
Starts distally and progresses proximally
Cold extremities, pain, trophic changes, ischemia, necrosis
Smoking cessation arrests the disease
52
What subjective clues will your patient give you about arterial disease during the evaluation
Cramping with walking (intermittent claudication)
Rest pain, relieved by dependency
Wounds may have no history of trauma
53
Arterial disease: objective Signs
Trophic skin changes-loss of hair growth, abnormal nails, dry skin
Cool skin
Decreased pulses
54
Vasculitis
inflammation of the vessel wall resulting from immune complex deposition or cell-mediated immune reactions directed against the vessel wall
cause unknown
55
Varicose veins
Abnormally dilated veins resulting from intrinsic vessel wall weakness and chronic valvular insufficiency
Increased risk of thrombosis and chronic venous insufficiency
56
Venous disease
Deep Vein Thrombosis (DVT)
Venous insufficiency-inadequate drainage of venous blood (also called venous hypertension)
Chronic venous insufficiency
57
Risk factors for venous disease
```
Aging
Pregnancy
Obesity
Long hours of standing/sitting
Lack of regular activity
Family history
```
58
What venous disease “sounds” like (subjective information)
Aching, heavy legs
Sometimes relieved by elevation
Wounds may have no history of trauma
59
What venous disease “looks” like- objective information
Swelling (unilateral or bilateral)
Skin changes: hemosiderin deposits, fibrosis (hardening) of the skin
Pulses present
Wounds with drainage
60
Symptoms of chronic venous insufficiency;
Dilated veins, leg pain, edema, and cutaneous changes (stasis dermatitis)
61
Causes of chronic venous insufficiency:
Venous occlusion
Valvular defects
Problems with muscle pump
62
Medical Management of CVI
Surgical
Angioplasty
Stenting
Amputation
63
Arterial wound presentation:
```
Present anywhere distal to the ankle, often the foot/toes
Dry appearance
Pale tissue
Painful
No pulses
```
64
Venous wound presentation:
```
Present most often on the medial malleolus and lower leg
Large amounts of drainage
Red or dark granulation
Not always painful
Hyperpigmentation
Pulses
```
65
Arterial wound characteristics:
Anywhere on leg or foot; bony prominences
Painful esp. with LE elevation
Pulses poor or absent
Minimal drainage
Blanched wound base
Well-circumscribed or “punched-out” borders
66
Venous wound characteristics:
```
Usually on medial aspect of distal 1/3 of leg
Not often painful
Normal pulses
Moderate to heavy drainage
Red wound base
Irregular borders and dark pigmentation
```
67
Primary lymphatic dysfunction
Primary
| Congenital – Failure of complete formation of lymph vessels
68
Secondary lymphatic dysfunction
Secondary
| Caused by trauma, surgery, parasitic infection, radiation, etc
69
Pathophysiology of lymphatic dysfunction:
Capillaries become more permeable
Damaged lymphatic system can’t keep up
Edema develops
Can lead to soft tissue fibrosis
70
Risk factors for lymphedema
```
Hereditary/congenital factors
Breast cancer (and other cancers) with surgical and radiation therapy procedures
Long standing edema
Paralysis
Damage during surgical procedures
Filariasis
```
71
What lymphedema “sounds like”- subjective information
Feelings of fullness and heaviness
| Numbness/tingling
72
What lymphedema “looks” like- objective information
```
Swelling, not usually improved with elevation
Pitting non pitting edema with fibrosis
Dermal changes: cysts, hyperkeratosis
Decreased ROM
Lymph leakage
```
73
Neuropathy Risk Factors:
```
Diabetes
Spina bifida
Lupus
HIV/AIDS
Chemotherapy
MS
Vascular disease
```
74
What neuropathy looks like-
| subjective information
Gradual onset with tingling, numbness
| Acute onset with significant pain sensory loss
75
What neuropathy looks like-
| objective information
```
Loss of protective sensation
Skin changes
Inflammation
Ulceration
Infection
Foot deformity
Pulses may or may not be present
```
76
Neuropathic wounds
Typically pain free
Often on the plantar aspect of the foot
Punched out appearance
Calloused edges
77
Charcot’s Joint
Joint breakdown
| Feet sensory, motor, and anatomic issues
78
Process of Charcot's joint:
Bone decalcification on joint surfaces
Boney overgrowth about the margins
P usually absent – some exceptions
Deformity & instability characteristic
79
Physiology of Wound Healing
Inflammatory phase
Proliferative phase
Maturation phase
80
Inflammatory phase
Vasodilatation, migration of leukocytes, histamine release (redness, heat, swelling, pain)
Platelet-derived growth factors facilitate migration of granulocytes and macrophages
81
Proliferative phase
Formation of granulation tissue (collagen + vascular network), wound contraction, re-epithelialization
82
Maturation phase
Day nine up to two years
Remodeling of new skin
Collagen re-organized & tensile strength increases
Continues even after wound closure (overlap with proliferation phase)
PT wound intervention at this stage
83
Pressure Ulcer:
ocalized area of tissue necrosis as a result of pressure - Also called decubitus ulcers
84
Venous Stasis Ulcer:
Wounds that arise on the lower leg as a result of venous insufficiency
85
Arterial Ulcer:
Wounds that arise on the lower leg or foot as a result of arterial insufficiency, or lack of blood flow to the tissue
86
Neuropathic Ulcer:
Wounds that arise in diabetic individuals as a result of insensate extremity
Also occur in persons with Hansen’s disease
87
Pressure Ulcer Etiology:
```
mechanical injury (pressure, friction, shear) or
moisture/Chemical damage
```
88
Venous Ulcer Etiology:
Venous insufficiency
Edema/swollen leg
Stasis
Micro trauma
89
Arterial Ulcer Etiology:
Lack of blood flow
| Peripheral vascular disease
90
Neuropathic Ulcer Etiology:
Diabetes/Hansen’s Disease
Peripheral Neuropathy
Insensate Extremity
Pressure
91
Stage 1 Pressure Ulcer:
Skin intact; Involves epidermis - hyperemic response; Can’t blanche skin
92
Stage 2 Pressure Ulcer:
Skin is broken; Involves dermis; Superficial; May appear as blisters
93
Stage 3 Pressure Ulcer:
Full thickness loss into subcutaneous fat; May have necrotic tissue, tunneling, exudate and/or infections.
94
Stage 4 Pressure Ulcer:
Full thickness - extends into muscle and/or bone or tendons
95
Venous Stasis Ulcer Appearance/Location:
Pain is mild and relieved by elevation
Proximal to medial malleolus or gaiter area of leg
Shallow with irregular shape, granular base, oozing
Stasis dermatitis, hyperpigmentation, palpable pulses
96
Arterial Ulcer appearance/location:
Pain is severe, exacerbated by elevation
Distal to medial malleolus, on dorsum of foot and toes
Irregular edge, poor granulation tissue, little bleeding
Trophic skin changes, absent pulses
97
Neuropathic Ulcer appearance/location:
Pain Free
Along pressure points of foot, first or fifth metatarsal head
Punched out, callous edges, deep sinus, brisk bleeding
Neuropathy, warmth, variable pulses
98
Risk factor for pressure ulcer:
```
Decreased Mobility
Lack of Sensation
Impaired Nutrition/Low Body Weight
Incontinence
Impaired Hydration
Decreased Cognitive Status
Obesity
Decreased Diastolic BP
Medical Co-morbidity
Ischemia
Anemia
Age
Infection
Polypharmacy
```
99
Venous Stasis ulcer risk factor:
Lymphoedema
Obesity
Pregnancy
Cancer hx
100
Arterial ulcer risk factor:
PVD
Diabetes
CAD
Stroke
101
Neuropathic ulcer:
Any dx with sensory loss but motor sparing
102
Pressure ulcer treatment
```
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment
Eliminate Pressure
E-stim
Patient Education
Mobility Training
```
103
Venous stasis ulcer treatment
```
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment Edema control - bandaging/compression
Patient Education
```
104
Arterial ulcer treatment
```
Remove necrotic tissue
Manage exudate
Eliminate infection
Surgical Consult
Patient Education
Increase circulation (US/PSWD/E-stim)
```
105
Neuropathic ulcer treatment
```
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment
Pressure Relief - casting
Patient Education
E-stim
```
