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Prosthetics > surgical techniques > Flashcards

surgical techniques Flashcards

1
Q

levels of amp based on

A

vascular disease - lvl selected based on anticipated viability

postop fx - most distal possible

disarticulations - most wont perform at knee or ankle joint due to poor circulation

traumatic amps - lvl determined based on nature of injury

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2
Q

myoplasty

A

Attachment of anterior and posterior compartment muscles to each other over the end of the bone
Better in the presence of ischemia

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3
Q

myodesis

A

Anchoring of muscles to bone

Increased stability and muscular control

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4
Q

open amp vs closed amp

A

open is Utilized if infection present or not enough tissue to provide good closure initially

closed is where skin flaps wrap the leg like a present either equal or post longer

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5
Q

skin flaps meet in the middle closed amputation

A

Skew sagittal flaps – midial lateral flap that meets in the middle

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6
Q

shortest lvl of fx for BKA

A

at the tibial tubs

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7
Q

the fibula in a BKA is

A

gen cut 1 cm shorter

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8
Q

why is ACE wrapping important

A

so we don’t get a light bulb shaped lib and keep a nice cylinder

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9
Q

AKA is common in

A

people with poor circulation

or gangrene foot/ankle

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10
Q

Reasons for choosing transfemoral v transtibial include

A

Trauma
Gangrene that has extended to knee
Circulatory status indicating poor chance of healing at transtibial level

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11
Q

postitioning for AKA pts right after surgery

A

EX and AD

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12
Q

why do the limbs what to go into FL and AB

A

the shorter the femur is the more mechanical advantage the quads have and the more AD lost

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13
Q

common issues post op with all amp

A 
pain 
Wound healing
Fluid collection/edema
Heterotrophic ossification
Trauma
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14
Q

common issues post op with transtibial

A

knee FL contracture

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15
Q

common issues with transfemoral post op

A

Hip adductor roll – have to get the ACE wrap all the way to the groin
Hip flexor contracture
Hip abduction contracture
Glute weakness

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16
Q

what is a contracture caused by

A

Immobility which leads to connective tissue proliferation into the joint space

17
Q

what can a contracture lead to

A

Can lead to: pain, pressure ulcers, further immobility and functional deficits

18
Q

what is osseointergration

A

where they connect the prosthetic straight to the femur and it takes many surgeries but no need for a socket

19
Q

what are the downsides of osseointergration

A 
Multiple surgeries
Prolonged period of no ambulation
Risk of fracture, infection
Reduction in activities that require high torque or axial stress
Not well known in the U.S.
20
Q

heicorporectomy

A

below waist amputation, B LE amputated

21
Q

transpelvic amp

A

amputation of portion of the pelvis and lower extremity

22
Q

hip disarticulation

A

: amputation through hip joint capsule including the entire lower extremity

23
Q

knee disarticulation

A

Inability to provide adequate transtibial residual limb secondary to trauma

Knee flexion contracture >45 degrees,

Infection of soft tissue close to knee joint

Congenital deformities
Rarely used in individuals with vascular compromise

24
Q

ankle disarticulation amp

A

also called symes amp

preserves the heel pad

used for severe foot trauma

must have circulation

25
Q

main take aways for surgical procedures

A

Reason for amputation is key for treatment
Level and amputation type are important for rehabilitation
Limb shape is vital to prosthetic use, and therefore function
Expect impairments in muscle length, strength, and motor control – joint position following amputation surgery
Don’t forget about co-morbidities – HTN CVA
`

26
Q

psychological considerations for positive adjustments after amp is

A

premorbid coping mech

how well they could handle stress and unexpected life events before ths

27
Q

4 stages of emotional adjustment

A

1st prior to surgery – 1st stage
Immediately after surgery - second
After initiation of postoperative program - third
Reintegration into functional lifestyle - forth

28
Q

immediately after surgery

A

may express relief

or grief is traumatic - could be euphoric or overly cheerful

29
Q

acknowledgement phase

A

Overwhelming with information may lead to greater helplessness
Private or group sessions with individuals who have made successful adjustments may be helpful
Feelings can alternate between hopelessness, despondency, bitterness and anger

30
Q

adaptation concerns

A

appearance
Fx
unrealistic expectations

31
Q

one thing you should ask your pt that is rarely asked

A

sexual issues - may be affected

32
Q

phantom sensation

A

Sensation that the absent limb is still there in some form

most distal usually felt

33
Q

recent theory on phantom sensation

A

sensation and pain originate in cerebrum

Current research includes looking into sensory reintegration and reorganization

34
Q

phantom pain

A

Phantom pain

Cramping or squeezing sensation, shooting pain or burning pain

35
Q

most pop tx for phantom pain

A

mirror box system

36
Q

age considerations for amp children

A

Parental adjustment is important because greatly influences the child’s adjustment
Children adapt fairly easily to the use of orthotic or prosthetic
Comfort is most important
Early adolescence may fear rejection and social ostracism
Compliance may also be an issue - teens
Involvement in sports programs is extremely helpful

37
Q

age considerations for amp elderly

A

maintaining independence
May be viewed as the end to an active lifestyle
Learning to use artificial limb or orthosis may be slow and discouraging
consider comorbidities

38
Q

considerations for caregivers

A

Can be stressful for caregivers as well
Important to have an awareness of caregiver concerns
Can they physically handle caring for the patient
Provide time for caregiver to ask questions as well

39
Q

main takeaways for phychosocial

A

Complex issues require team approach
Pre-amputation coping mechanism can determine psych outcome
Trauma v. Vascular
Not just the patient
Children adjust quickly, but compliance can be an issue throughout teen years

Prosthetics (3 decks)

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