surgical techniques Flashcards
levels of amp based on
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
myoplasty
Attachment of anterior and posterior compartment muscles to each other over the end of the bone
Better in the presence of ischemia
myodesis
Anchoring of muscles to bone
Increased stability and muscular control
open amp vs closed amp
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
skin flaps meet in the middle closed amputation
Skew sagittal flaps – midial lateral flap that meets in the middle
shortest lvl of fx for BKA
at the tibial tubs
the fibula in a BKA is
gen cut 1 cm shorter
why is ACE wrapping important
so we don’t get a light bulb shaped lib and keep a nice cylinder
AKA is common in
people with poor circulation
or gangrene foot/ankle
Reasons for choosing transfemoral v transtibial include
Trauma
Gangrene that has extended to knee
Circulatory status indicating poor chance of healing at transtibial level
postitioning for AKA pts right after surgery
EX and AD
why do the limbs what to go into FL and AB
the shorter the femur is the more mechanical advantage the quads have and the more AD lost
common issues post op with all amp
pain Wound healing Fluid collection/edema Heterotrophic ossification Trauma
common issues post op with transtibial
knee FL contracture
common issues with transfemoral post op
Hip adductor roll – have to get the ACE wrap all the way to the groin
Hip flexor contracture
Hip abduction contracture
Glute weakness
what is a contracture caused by
Immobility which leads to connective tissue proliferation into the joint space
what can a contracture lead to
Can lead to: pain, pressure ulcers, further immobility and functional deficits
what is osseointergration
where they connect the prosthetic straight to the femur and it takes many surgeries but no need for a socket
what are the downsides of osseointergration
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.
heicorporectomy
below waist amputation, B LE amputated
transpelvic amp
amputation of portion of the pelvis and lower extremity
hip disarticulation
: amputation through hip joint capsule including the entire lower extremity
knee disarticulation
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
ankle disarticulation amp
also called symes amp
preserves the heel pad
used for severe foot trauma
must have circulation
main take aways for surgical procedures
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
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psychological considerations for positive adjustments after amp is
premorbid coping mech
how well they could handle stress and unexpected life events before ths
4 stages of emotional adjustment
1st prior to surgery – 1st stage
Immediately after surgery - second
After initiation of postoperative program - third
Reintegration into functional lifestyle - forth
immediately after surgery
may express relief
or grief is traumatic - could be euphoric or overly cheerful
acknowledgement phase
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
adaptation concerns
appearance
Fx
unrealistic expectations
one thing you should ask your pt that is rarely asked
sexual issues - may be affected
phantom sensation
Sensation that the absent limb is still there in some form
most distal usually felt
recent theory on phantom sensation
sensation and pain originate in cerebrum
Current research includes looking into sensory reintegration and reorganization
phantom pain
Phantom pain
Cramping or squeezing sensation, shooting pain or burning pain
most pop tx for phantom pain
mirror box system
age considerations for amp children
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
age considerations for amp elderly
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
considerations for caregivers
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
main takeaways for phychosocial
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
