Surgical Techniques and Outcomes Flashcards
List the post-op phases and what is indicated by each
Acute (between surgery and discharge from acute care)
Pre-prosthetic (fitting/decision)
Prosthetic phase
What are the 2 most common amputation prevention procedures and what populations are they associated with?
PAD> Angioplasty/stenting or LE Bypass graft
Cancer/Trauma> limb salvage procedure (in trauma mainly soft tissue)
Factors affecting Level of Amputation
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??)
What is the difference between myoplasty and myodesis?
Myoplasty attaches ant/post muscles (better for ischemia) whereas myodesis anchors the muscle to bone (for increased stability and motor control)
Describe the shape and positioning of skin flaps after amputation.
broad as distal end of the limb; shape allows the corners to retract
when might you see an open amputation?
when there is an infection or not enough tissue initially for a closure
Describe the 3 types of closed amputations.
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
list the 2 main LE amputations.
transtibial and transfemoral
What bony landmark denotes the shortest a BKA can be while still maintaining knee function? Why?
tibial tubercles (tuberosity) It is the attachment point for the quads and hamstrings
which shape are we aiming for in the residual limb? Conical or cylindrical?
Cylindrical
what structural considerations are made for BKAs (transtibial amputations) and why?
fibula cut 1 cm shorter than tibia: shaping
beveled (rounded ) ends: preventing soft tissue impingement
bone between the 2, prevents lateral fibular translation
why might you chose a transfemoral amp over a transtibial one?
trauma, gangrene that has reached the knee, circulatory status that indicates poor healing for BKA.
What are pros and cons for AKAs? What populations are they traditionally most common in?
pro:better circulation above the knee
con: more energy for ambulation
population:dysvascular, gangrene
describe the skin flaps for an AKA
equal length or long medial flap (sagittal plane)
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?
EXT and ADD
What are 4 common problems all amputees face post-op? BKAs?
pain, wound healing, edema,
for trauma heterotrophic ossification (bone overgrowth into muscle)
Knee flexion contracture
What’s a contracture? What causes it?
connective tissue becomes more fibrotic than viscoelastic and it reduces joint mobility .Immobility> tissue proliferation + change in muscle/cartilage composition
what are 4 consequences of contractures?
pain, pressure ulcers, further immobility, functional deficit
what are 4 benefits of osseointegration?
-eliminates need for socket (less breakdown)
-natural and -improved gait
-short residual lim friendly
-allows normal -swelling
what are some cons to osseointegration?
multiple surgery
delayed ambulation
risk of fracture or infection
not well known in US
decreased activities the req high axial stress or torque
describe the 3 types of hip and pelvis amps.
hemicorporectomy- below waist- B LE
transpelvicamp part of pelvis and LE
hip disarticulation-throgh hip jint capsule
what is the structural concern for hip and transpelvic amps?
soft tissue flap for pressure tolerance and pressure in sitting
list the indications for knee disarticulations (4)
trauma> no transtibial limb
knee flexure above 45*, infected soft tissue near knee joint, congenital
what is a Symes disarticulation and what are its indications?
amputation through ankle preserving the heel pad;
used for severe foot trauma, congenital abnormality, gangrene of forefoot
List the 3 foot amputations
transmetatarsal (@ distal metatarsals)
Lisfranc (tarsometatarsal disart)
Chopart (midtarsal disart )
what are 4 types of primary dressings you’d expect to see post-op?
compressive soft
shrinker
semi-rigid dressing
IPOP
list pros (3) and cons (3) for using a compressive soft dressing
*easy app, cheap, access to incision
-little edema ctrl, frequent wrapping and inconsistent technique
list pros (2) and cons (3) for using a shrinker dressing
*easy to apply, cheap
-sutures MUST be removed, req changing, tourniquet effect
list pros (2) and cons (3) for using a semi-rigid dressing
*edema ctrl,
limb protection
-frequent changing, no pt app, no access to incision
list pros (3) and cons (3) for using a immediate post-surgicalprosthesis (IPOP)
*great edema ctrl and protection, controls pain
-limited access to incision, requires more training, expensive,
when is rigid/semi-rigid dressing applied?
in OR or recovery room for immediate prosthetic fitting (not for infections as it adheres to skin)
when are soft dressings applied?
immediately post-op (above guaze and Kerlix) , w/ ace-wrap, Compressogrip, Tubigrip or shrinker w/ limb protector on top
What specific type of muscle impairments might you see following an amputation surgery?
muscle length, strength, and motor control
