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Prosthetics > Pre-Op Care > Flashcards

Pre-Op Care Flashcards

1
Q

Incidence of amputation

A
  1. Age - rate of amputation increases steeply with age. 65-85 yo greatest risk.
  2. LE > UE
  3. Men > women both in trauma and disease
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2
Q

What is the most common contributing factor for non-traumatic LE amputations?

A
  • Dysvascular Disease (PVD/PAD)
  • Prevalence increases with age
  • Risk factors: diabetes, HTN, dyslipidemia, smoking, age
  • Classic indicators: loss of one or more peripheral pulses and intermittent claudication.
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3
Q

What are most common causes of death post-amputation

A
  1. Diabetes
  2. Cardiovascular disease
  3. Renal disease
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4
Q

Age is an important predictor of what…

A
  1. Healing time
  2. Total time in rehab
  3. Achievement of functional ambulation
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5
Q

What is a traumatic amputation

A

An injury to an extremity that results in immediate separation of the limb or will result in loss of the limb as a result of accident or injury.

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6
Q

What is involved in the extent of an injury in traumatic amputations

A
  1. Movement of the object causing injury
  2. Partial vs. Complete
  3. Direction, magnitude, and speed of energy vector
  4. Particular body tissue involved
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7
Q

What is revascularization window and considerations

A
  • 6-12 hour window of injury
  • considerations: age, health status, level of injury, condition of amputated part.
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8
Q

what is replantation window and considerations

A
  • 3-6 hour window
  • Most successful in distal UE
  • Goal is to provide mechanism for functional grip in UE.
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9
Q

What are indications of replantation surgery

A
  1. Amputations in children
  2. Multiple finger and hand amputations
  3. Thumb amputation
  4. Single finger
  5. Ring avulsion injuries
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10
Q

Contraindications for replantation surgery

A
  1. Severe crush injury
  2. Prolonged warm ischemia
  3. Severe contamination
  4. Medical comorbidities
  5. Life-threatening injuries
  6. Refusal to accept blood transfusion or blood products.
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11
Q

Incidence of amputations due to cancer are reduced by…

A

Improvements in detection/imaging techniques, chemo, limb salvage procedures.

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12
Q

What are some cancers that could lead to amputations

A
  1. Osteosarcoma — growing end of long bones. Common in teens to young adults M>F. Common in distal femur/proximal tibia
  2. Chondrosarcoma — cartilage
  3. Ewings sarcoma — axial skeleton
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13
Q

What are common limb malformations seen at birth

A
  • Amelia — absence of entire limb
  • Transverse deficiencies — described by the level at which the limb terminates
  • Longitudinal deficiencies — reduction or absence within the long bone, but normal skeletal components are present distal to the affected bones.
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14
Q

What are goals for children’s prostheses

A
  1. Enhance the function of the limb for the most effective use of the prosthesis
  2. Provide cosmetic replacement for the missing limb.
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15
Q

Describe rehab and introduction to prosthesis for children

A

Rehab is designed with cognitive, motor, and psychological development in mind.
Introduction of prosthesis depends on UE vs. LE.
- UE = as early as 4-6 months
- LE = around 8-12 months

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16
Q

What is clinical presentation of proximal femoral focal deficiency?

A
  1. Shorter lower limb (above knee)
  2. Knee in proximal position or non-existent
  3. Usually normal foot
17
Q

level of amputation

A
  1. Guided by soft tissue coverage and residual limb length
  2. Remove all non-viable tissues and structures
  3. Ability to successfully heal at the incision, based on the adequacy of circulation
  4. preserve as many anatomical joints as possible to improve the ability to achieve long-term functional residual limb.
18
Q

What are forefoot considerations for pedal amputations

A
  1. Toes are expendable
  2. Minimal functional loss
  3. Transfer lesions on ball of feet
  4. Toes are like teeth and can shift over time
  5. Toe filler insoles and accommodate defects
19
Q

Mid-shaft MT amputation facts

A
  1. Beveled in a dorsal-digital to plantar-proximal direction
  2. Rounding of boney prominences
  3. Skin flaps — extend from plantar to dorsal directions
20
Q

Indications for transtibial/transfemoral amputation

A
  1. Extensive tissue destruction from non-healing or infected ulceration
  2. Vascular insufficiency
  3. Vascular reconstruction is not possible or not successful
  4. Failure of a more distal amputation
  5. Combination of above factors
21
Q

Advantages of knee disarticulation

A
  1. Intact bone in residual limb
    — decrease chance of osteomyelitis
    — maintains intact growth plates
  2. Longer lever arm and improved prosthetic control
  3. Distal weight bearing
22
Q

Disadvantages of knee disarticulation

A
  1. Decreased Cosme sis of the prosthetic replacement
  2. Fewer components are available to fit the smaller joint space.
23
Q

What is an ankle disarticulation/syme’s disarticulation?

A
  1. Talus is disarticulated from tibia and fibula
  2. Heel pad is swung under the tibia and fibula and stabilized after skin closure until the heel pad has securely adhered
  3. Weight bearing amputation
24
Q

What is a Boyd and pirogoff amputation

A

Bony fusion of tibia and calcaneus.
- better result than syme’s because of leg length and flap stability/vascularity

25
Q

What is amputation level of transfemoral patient

A

Usually at the junction of the middle and distal 1/3 of the femur.

26
Q

What is amputation level of transtibial patients

A
  • 2.5 cm of residual limb for every 30 cm of patient height. (12-15cm for most people)
  • Fibula is cut about 1cm shorter than tibia which may be fixated to tibia if Inter osseous membrane is disrupted and may even be removed if the limb is very short.
27
Q

What happens with nerves and blood vessels during amputation

A
  1. Major nerves are pulled down firmly, respected sharply, and allowed to retract into the soft tissue.
  2. When severed, nerves put out new tendrils that form into small neoplasms or nerve ends (neuromas)
  3. If neuromas are small and embedded well in the soft tissues, they are usually not a problem.
  4. Arteries and veins are ligated
28
Q

How are muscles handled with amputations

A
  • A muscle must be attached at both ends to allow it to function
  • Muscles are stabilized under little tension to provide a well-shaped residual limb.
    usually incorporated with myofascial closure to make sure they don’t slide off the end of the bone
29
Q

What is myodesis

A

Anchoring of muscle to the bone

30
Q

What is myoplasty

A
  • Attachment of medial/lateral and anterior/posterior compartment muscles to each other over the end of the bone.
31
Q

Bone handling in amputations for transtibial vs. Transfemur move

A

Transtibial
- Tibia = cut and beveled anteriorly
- Fibula = usually 1/2 - 1 inch shorter
- Ertl Procedure = bony fixation of distal tibia and fibula

Transfemoral
- Ideal length is between middle/distal 1/3 of the femur
- Edges are beveled.

32
Q

Skin handling in amputations

A
  1. Transtibial = usually a long posterior flap — pulled anteriorly around distal end
  2. Transfemoral = usually equal anterior/posterior flaps — incision in frontal plane.

Prosthetics (7 decks)

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