Surgical Techniques and Outcomes

Question 1

List the post-op phases and what is indicated by each

Answer 1

Acute (between surgery and discharge from acute care)
Pre-prosthetic (fitting/decision)
Prosthetic phase

Question 2

What are the 2 most common amputation prevention procedures and what populations are they associated with?

Answer 2

PAD> Angioplasty/stenting or LE Bypass graft
Cancer/Trauma> limb salvage procedure (in trauma mainly soft tissue)

Question 3

Factors affecting Level of Amputation

Answer 3

Vascular disease
Postop function
Disarticulations (not at knee or ankle joint due to poor circulation probs)
Trauma and malignancy (how much of it is bad??)

Question 4

What is the difference between myoplasty and myodesis?

Answer 4

Myoplasty attaches ant/post muscles (better for ischemia) whereas myodesis anchors the muscle to bone (for increased stability and motor control)

Question 5

Describe the shape and positioning of skin flaps after amputation.

Answer 5

broad as distal end of the limb; shape allows the corners to retract

Question 6

when might you see an open amputation?

Answer 6

when there is an infection or not enough tissue initially for a closure

Question 7

Describe the 3 types of closed amputations.

Answer 7

equal length ant/poster (to conserve bone length or when primary healing is fine), flaps shaped to reduce dog ears

long posterior flap: when vascularity is of concern or more padding necessary

Skew sagittal flaps:
for serve dysvascular disease, increases lat blood flow and moves placement of scar to reduce prosthetic friction

Question 8

list the 2 main LE amputations.

Answer 8

transtibial and transfemoral

Question 9

What bony landmark denotes the shortest a BKA can be while still maintaining knee function? Why?

Answer 9

tibial tubercles (tuberosity) It is the attachment point for the quads and hamstrings

Question 10

which shape are we aiming for in the residual limb? Conical or cylindrical?

Answer 10

Cylindrical

Question 11

what structural considerations are made for BKAs (transtibial amputations) and why?

Answer 11

fibula cut 1 cm shorter than tibia: shaping
beveled (rounded ) ends: preventing soft tissue impingement
bone between the 2, prevents lateral fibular translation

Question 12

why might you chose a transfemoral amp over a transtibial one?

Answer 12

trauma, gangrene that has reached the knee, circulatory status that indicates poor healing for BKA.

Question 13

What are pros and cons for AKAs? What populations are they traditionally most common in?

Answer 13

pro:better circulation above the knee
con: more energy for ambulation

population:dysvascular, gangrene

Question 14

describe the skin flaps for an AKA

Answer 14

equal length or long medial flap (sagittal plane)

Question 15

When we say maintenance of femoral shaft axis is key, what 2 direction should we encourage the residual limb to be in to maximize alignment?

Answer 15

EXT and ADD

Question 16

What are 4 common problems all amputees face post-op? BKAs?

Answer 16

pain, wound healing, edema,
for trauma heterotrophic ossification (bone overgrowth into muscle)

Knee flexion contracture

Question 17

What’s a contracture? What causes it?

Answer 17

connective tissue becomes more fibrotic than viscoelastic and it reduces joint mobility .Immobility> tissue proliferation + change in muscle/cartilage composition

Question 18

what are 4 consequences of contractures?

Answer 18

pain, pressure ulcers, further immobility, functional deficit

Question 19

what are 4 benefits of osseointegration?

Answer 19

-eliminates need for socket (less breakdown)
-natural and -improved gait
-short residual lim friendly
-allows normal -swelling

Question 20

what are some cons to osseointegration?

Answer 20

multiple surgery
delayed ambulation
risk of fracture or infection
not well known in US
decreased activities the req high axial stress or torque

Question 21

describe the 3 types of hip and pelvis amps.

Answer 21

hemicorporectomy- below waist- B LE
transpelvicamp part of pelvis and LE
hip disarticulation-throgh hip jint capsule

Question 22

what is the structural concern for hip and transpelvic amps?

Answer 22

soft tissue flap for pressure tolerance and pressure in sitting

Question 23

list the indications for knee disarticulations (4)

Answer 23

trauma> no transtibial limb
knee flexure above 45*, infected soft tissue near knee joint, congenital

Question 24

what is a Symes disarticulation and what are its indications?

Answer 24

amputation through ankle preserving the heel pad;

used for severe foot trauma, congenital abnormality, gangrene of forefoot

Question 25

List the 3 foot amputations

Answer 25

transmetatarsal (@ distal metatarsals)
Lisfranc (tarsometatarsal disart)
Chopart (midtarsal disart )

Question 26

what are 4 types of primary dressings you’d expect to see post-op?

Answer 26

compressive soft
shrinker
semi-rigid dressing
IPOP

Question 27

list pros (3) and cons (3) for using a compressive soft dressing

Answer 27

*easy app, cheap, access to incision

-little edema ctrl, frequent wrapping and inconsistent technique

Question 28

list pros (2) and cons (3) for using a shrinker dressing

Answer 28

*easy to apply, cheap

-sutures MUST be removed, req changing, tourniquet effect

Question 29

list pros (2) and cons (3) for using a semi-rigid dressing

Answer 29

*edema ctrl,
limb protection

-frequent changing, no pt app, no access to incision

Question 30

list pros (3) and cons (3) for using a immediate post-surgicalprosthesis (IPOP)

Answer 30

*great edema ctrl and protection, controls pain

-limited access to incision, requires more training, expensive,

Question 31

when is rigid/semi-rigid dressing applied?

Answer 31

in OR or recovery room for immediate prosthetic fitting (not for infections as it adheres to skin)

Question 32

when are soft dressings applied?

Answer 32

immediately post-op (above guaze and Kerlix) , w/ ace-wrap, Compressogrip, Tubigrip or shrinker w/ limb protector on top

Question 33

What specific type of muscle impairments might you see following an amputation surgery?

Answer 33

muscle length, strength, and motor control