Unit 1: Amputation Surgery Flashcards
What are the 3 main aims of amputation surgery
Save life
Relieve pain
Restore function
What is amputation
The surgical removal of part or all of a limb
What are 2 main goals of amputation surgery outcomes
Ablate a diseased/devitalised part
Reconstruct a stable, functional and painfree segment
What are the 7 main causes of amputation
Atherosclerosis Diabetes Trauma Infection Tumours Congenital deformity Others: secondary deformities/pseudarthrosis
Give examples of acute and chronic infections that lead to amputations
Acute: gas gangrene (clostridium Welchii), meningococcal septicaemia
Chronic: osteomyelitis, non-healing ulcers
List the levels of lower limb amputation
Trans-pelvic Hip disarticulation Trans-femoral Knee disarticulation Trans-tibial Ankle disarticulation Partial foot
What is the basic principle of upper limb amputation surgery
To preserve as much length as possible
Identify 5 main methods of identifying the best level of amputation
Clinical evaluation Systolic BP (Doppler) Infra-red thermography Skin blood flow measurement Microlight guided spectrophotometry
At what thigh blood pressure should trans-tibial amputation be considered worth attempting at
When thigh BP >70-80mmHg
How is skin bloodflow measured
Inject radionucleotide with 125 I-4iodoantipyrine tracer
Measure time taken for washout
At what bloodflow rate should above knee amputation be performed
If mean flow is <2.5ml/100g/min
What does microlight guided spectrophotometry measure
The oxygenation of haemoglobin using xenon light
Why is spinal/regional anaesthesia preferred over other types
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
When should tourniquets be avoided
In dysvascular patients
In acute trauma where tissue viability is in doubt
Why should vacuum drainage be used for 48hrs after amputation
To prevent haematoma formation
What is the difference between myodesis and myoplasty
Myodesis: attachment of the muscles to the stump
Myoplasty: end-to-end suturing of antagonistic muscle groups over the end of the stump
Which 4 groups of muscles are sutured during myodesis in a transfemoral amputation
Abductors and adductors then quads and hamstrings
What 3 factors contribute to speedy wound healing
Optimum preparation of the patient for surgery with respect to associated conditions
Pre-op preparation of the limb to prevent infection
Prophylactic measures
Identify factors that delay wound healing
Smoking Low Hb levels Poor nutrition Previous vascular surgery Diabetes Inexperienced surgeon
What dressing is used for knee disarticulations and amputations distal to this level
Plaster of Paris
What dressing is used for transfemoral and more proximal amputations
Simple Elastoplast adhesive dressing
What are 3 immediate complications of amputation surgery
Infection
Stump pain
Haematoma formation
What are 4 late complications of amputation surgery
Painful neuroma
Phantom phenomena
Skin problems
Change in stump volume
