Unit 1: Amputation Surgery

Question 1

What are the 3 main aims of amputation surgery

Answer 1

Save life
Relieve pain
Restore function

Question 2

What is amputation

Answer 2

The surgical removal of part or all of a limb

Question 3

What are 2 main goals of amputation surgery outcomes

Answer 3

Ablate a diseased/devitalised part

Reconstruct a stable, functional and painfree segment

Question 4

What are the 7 main causes of amputation

Answer 4

Atherosclerosis
Diabetes 
Trauma
Infection
Tumours
Congenital deformity
Others: secondary deformities/pseudarthrosis

Question 5

Give examples of acute and chronic infections that lead to amputations

Answer 5

Acute: gas gangrene (clostridium Welchii), meningococcal septicaemia
Chronic: osteomyelitis, non-healing ulcers

Question 6

List the levels of lower limb amputation

Answer 6

Trans-pelvic
Hip disarticulation
Trans-femoral
Knee disarticulation
Trans-tibial
Ankle disarticulation
Partial foot

Question 7

What is the basic principle of upper limb amputation surgery

Answer 7

To preserve as much length as possible

Question 8

Identify 5 main methods of identifying the best level of amputation

Answer 8

Clinical evaluation
Systolic BP (Doppler)
Infra-red thermography
Skin blood flow measurement
Microlight guided spectrophotometry

Question 9

At what thigh blood pressure should trans-tibial amputation be considered worth attempting at

Answer 9

When thigh BP >70-80mmHg

Question 10

How is skin bloodflow measured

Answer 10

Inject radionucleotide with 125 I-4iodoantipyrine tracer

Measure time taken for washout

Question 11

At what bloodflow rate should above knee amputation be performed

Answer 11

If mean flow is <2.5ml/100g/min

Question 12

What does microlight guided spectrophotometry measure

Answer 12

The oxygenation of haemoglobin using xenon light

Question 13

Why is spinal/regional anaesthesia preferred over other types

Answer 13

Complete pain relief of immediate post-op pain
Reduction of cardio-pulmonary problems
Reduction of confusional state
Reduction in opiate requirement 
Prevention of joint flexion

Question 14

When should tourniquets be avoided

Answer 14

In dysvascular patients

In acute trauma where tissue viability is in doubt

Question 15

Why should vacuum drainage be used for 48hrs after amputation

Answer 15

To prevent haematoma formation

Question 16

What is the difference between myodesis and myoplasty

Answer 16

Myodesis: attachment of the muscles to the stump
Myoplasty: end-to-end suturing of antagonistic muscle groups over the end of the stump

Question 17

Which 4 groups of muscles are sutured during myodesis in a transfemoral amputation

Answer 17

Abductors and adductors then quads and hamstrings

Question 18

What 3 factors contribute to speedy wound healing

Answer 18

Optimum preparation of the patient for surgery with respect to associated conditions
Pre-op preparation of the limb to prevent infection
Prophylactic measures

Question 19

Identify factors that delay wound healing

Answer 19

Smoking
Low Hb levels
Poor nutrition
Previous vascular surgery
Diabetes
Inexperienced surgeon

Question 20

What dressing is used for knee disarticulations and amputations distal to this level

Answer 20

Plaster of Paris

Question 21

What dressing is used for transfemoral and more proximal amputations

Answer 21

Simple Elastoplast adhesive dressing

Question 22

What are 3 immediate complications of amputation surgery

Answer 22

Infection
Stump pain
Haematoma formation

Question 23

What are 4 late complications of amputation surgery

Answer 23

Painful neuroma
Phantom phenomena
Skin problems
Change in stump volume