P&O Lower Extremity Flashcards
1/3 of LE amputations were of teh ___
toe
Top four causes of LE amputation
- PVD/infection 70%
- Trauma 22%
- tumor 5%
- Congenital deformity 3%
Most common locations of LE amputation (top 2)
- transtibial 59%
2. Transfemoral 35%
What is a normal ABI?
PAD ABI?
Normal 0.91 - 1.30
Mild PAD 0.71 - 0.90
Moderate PAD 0.41 - 0.70
Severe PAD 0.00 to 0.40
ABI > 1.30 may suggest _____
calcified, noncompressible vessels which can produce falst negative results
- common in DM
what is the gold standard imaging test for PAD?
interarterial contrast angiography
Describe the difference between myodesis and myoplasty
myodesis - muscles and fasciae are sutured directly to bone through drill holes. Residual limb is more structurally sound. Contraindicated in severe dysvascularity in which the blood supply to the bone may be compromised
myoplasty - opposing muscles are sutured to each other and to the periosteum at the end of the cut bone with minimal tension. Generally takes less operating time. May be the procedure of choice in severe dysvascular residual limbs.
What is a symes ampuation
ankle disarticulation with attachment of heel pad to the distal end of tibia and may include the removal of malleoli and distal tibial/fibular flares
standard BKA is ____% of tibial length
20-50%
If amputation line is within _____ below tibial tubercle, might as well do a disartic
1cm
standard transfemoral AK is ____% of femur length
35-60%
Short BK are at risk for ____
knee flexion contractures. If above 1cm below tibial tubercle, might as well do knee disartic.
Very high AKAs are at risk for ____
flexion and abduction contractures at the hip joint
____- amputation is through the transmetatarsal junction
lisfranc
____ is an amputation at the midtarsal line. Only talus and calcaneus remain
chopart
_____ is a resection of a portion of up to three metatarsals and digitis
partial foot/ray resection
_____ is an amputation of both lower limbs and pelvis below L4/5 level
hemicorporectomy
Transmetatarsal amputations are important because they preserve:
the attachment of the dorsiflexors and plantar flexors and their function.
_____ amputaiton is a vertical calcaneal amputation
pirogoff
___ amputation is a horizontal calcaneal amputation
boyd
In both lisfranc and chopart amputations, the remaining foot often ____
develops significant equinovarus deformity resulting in excess anterior weight bearing with breakdown.
adequate dorsiflexor tendon reattachment with achilles tendon lengthening has been advocated to prevent this deformity.
4 “pros” of symes amputation
- maintains limb length
- there is preservations of the heel pad, providing excellent weight bearing residual limb
- early fitting of prosthesis is possible with excellent results
- partial weight bearing of the residual limb is possible almost immediately after the procedure with a proper rigid casting (approx within 24H)
Healing rate for dysvascular BK is ____%
80-90%
In a BKA, fibula should be cut _____ and the tibia should be _____
2-3cm shorter than the tibia
beveled anteriorly