Soft Tissue Injury Flashcards
What is the most common amputation site ?
The most common site for amputation is transtibial (below the knee)
Why do surgeons aim to keep as much of the limb as possible ?
To preserve knee function if possible,
increase leverage when using prosthetics and below knee prosthetics are much easier to use.
to preserve more muscle mass for rehabilitation/ recovery.
What are the 2 types of pain ?
Intrinsic Pain - Pain from inside the joint.
Extrinsic Pain - Pain from around/ outside the joint.
Intrinsic pain includes residual limb pain, phantom pain and post amputation pain.
How is amputation pain managed ?
pain medications/ antidepressants.
massage techniques
neuro modulation / hypnosis
physiotherapy.
What treatment options are available to the patient ?
Immediately after the amputation the wound is bandaged to reduce infection.
Dressings both soft and rigid are used.
Stump socks and compression garments are worn to prevent swelling and shape the stump.
What is a stump and what are the characteristics of an ideal stump ?
A stump is the remaining limb bone, nerve and tissue.
An ideal stump has no scarring on the contact surface, cleanly pulled and cut nerves and are cylindrical in shape which helps to reduce skin breakdowns.
What complications may occur as a result of the stump and how are they managed ?
Oedema build up which may prevent granulation tissue growth. treated via compression garments.
Contractures - shortening and hardening of tissue which reduces ROM. Treated via casts/ splints or through physiotherapy.
Stump Infection - can be treated via preventative antibiotics and sterile wound care.
What are the long term health complications associated with amputation ?
Deep Vein Thrombosis - blood clotting.
Phantom Limb Pain
Cardiac Issues such as myocardial infarction/ heart failure.
Psychological issues such as depression, anxiety and body image issues.
Kidney Injury
Pneumonia
Revision Surgery.
How are pressure ulcer wounds managed ?
Temperature taken as this is a measure of inflammation, infection or lack of circulation.
Wound debridement - removal of dead tissue from wounds. Grinding off dead tissue.
Warm moist wound healing environment.
To prevent, reduce the pressure on the foot, maintain hygiene and moisture and ensure proper nutrition.
Why is mobility important ?
Encouraged to reduce muscle atrophy in the area and provide psychological benefits to the patient.
Mobility can retain peripheral blood flow to the area of amputation possibly preventing secondary surgeries.
What Biomechanical principles are involved in lower limb prosthetics ?
Prosthetic alignment can alter the angles of the Ground Reaction Force and their magnitudes.
This alignment may also cause torques within the ankle joint.
Prosthetics should be rigid enough to deform to ankle dorsiflexion (lifting foot up).
Axial loading – forces going up/down the shaft. Important for prosthesis to be a medium for axial loading.
What soft tissue mechanics are involved in lower limb amputations?
Residual tissue may be damaged during rehabilitation.
It is important for the stump tissue to keep remodelling over time although this may lead to shrinkage in the wound size.
Prosthetic sockets should be designed to account for the muscle and fat levels of the stump as well as the load capabilities.
What is Haemostasis ?
A protective mechanism to stop bleeding and keep blood supply constant. Split into 3 stages (primary, secondary , fibrinolysis).
What are the stages of primary haemostasis ?
Vasoconstriction of the local area (to reduce flow and blood loss) and temporary platelet plug formation (caused by adhesion of the platelets).
What happens in the secondary haemostasis and fibrinolysis?
Secondary haemostasis where the coagulation cascade starts and the clot is stregnthened and fibrinolysis which dissolves the clot and replaces it with a fibrin plug once the integrity of the vessel has been restored and eventually a reduction in volume in the clot.
