Week 10 - Peripheral Vascular Disease and Amputations Flashcards
What is peripheral arterial disease (PVD)?
A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.
What are risk factors of PVD?
Smoking, older age, diabetes, high cholesterol, high blood pressure, heart disease and stroke.
What is the major cause of death of people with PVD?
Coronary heart disease
What is PVD also known as?
Arteriosclerosis obliterans
Arterial insufficiency of the legs
Claudication
Intermittent claudication
What caused PVD?
Fatty deposits or plaques build up along the walls of the arteries carrying blood to the arms and legs
What are the symptoms of PVD?
- Reduced hair growth
- Cramps
- Colour changes in skin
- Sores on legs and feet that do not heal promptly
- Burning or aching in the feet at rest
- Intermittent claudication
What is intermittent claudication?
Intermittent pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest.
What is claudication?
Pain, commonly in the legs, caused by too little blood flow, usually during exercise. Often indicates peripheral artery disease.
How is PVD diagnosed?
Physical examination Comparing ankle blood pressure with the BP of the arm (Ankle Brachial Index) Angiography Magnetic resonance angiography CTA Blood tests
How is PVD treated?
Quit smoking Exercise regularly Eat healthy diet Medications Vascular surgery and angioplasty Amputation
What are medications used for in PVD?
To reduce blood viscosity
Destroy platelets causing blockage
Lower Cholesterol
What is the prognosis of PAD?
If diagnosed early, most cases of PAD will respond to lifestyle treatments
What are the complications of PAD?
Tissue death - amputation Impotence Pain Reduced mobility Wounds Infections Heart attack Stroke
What are the 4 causes of upper limb amputation?
Trauma - 60%
Neoplasm (tumour) - 13%
Vascular - 6%
Infection - 5%
What are the 4 causes of lower limb amputation?
Vascular - 70-85%
Trauma - 22-24%
Neoplasm - 4-4.5%
Congenital - 26 per 100,000 infants
What is the highest cause of upper limb amputation?
Trauma
What is the highest cause of lower limb amputations?
Vascular
What is a partial foot amputation?
Distal to ankle joint
What is a transtarsal amputation?
Through the tarsus or foot bones
What is an amputation at the ankle joint called?
Ankle disarticulation
What is a Syme’s amputation?
Amputation at the ankle joint with the fatty heel pad retained for cushioning
What is an amputation between the knee joint and ankle joint called?
Trans-tibial amputation
What is a knee disarticulation?
An amputation at the knee joint
What is a trans-femoral amputation?
An amputation between the knee and the hip
What is an amputation at the hip leaving the pelvis intact called?
Hip disarticulation
What is a trans-pelvic amputation?
Amputation of the lower limb together with all or part of hemipelvis
What is a fingers or partial hand amputation?
Distal to the wrist joint
What is wrist disarticulation?
Amputation at the wrist joint
What is an amputation between the elbow and wrist joint called?
A trans-radial amputation
What is an elbow disarticulation?
Amputation at the elbow
What is a trans-humeral amputation?
Amputation between the elbow and shoulder joint
What is an amputation at the shoulder joint called?
Shoulder disarticulation
What is a forequarter amputation?
An amputation at the scapulo-thoracic & sternoclavicular joints
What are the primary impairments of amputation?
Loss of part of a limb
Loss of part or all of support ambulation
Motor loss
Sensory loss - light touch, pressure and proprioception
What are secondary impairments/co-morbidities of amputation?
Contractures Weakness Deconditioning Pain - surgical, scar, phantom, musculoskeletal Other foot compromised by PVD
What is preoperative care for amputation?
Psychological preparation
Increase strength and flexibility
Increase cardiovascular fitness
Management of pain
What is immediate post-op care for amputation?
Care of wound
Residual limb care – bandaging to shape the residual limb for prosthesis
What is mirror box?
Mirror therapy or mirror visual feedback is a therapy for pain or disability that affects one side of the patient more than the other side.
How do you prepare amputations for prosthesis?
Residual limb care – Pressure sock 24 hours/day (‐shower time)
- Care of scar area
- massage and mobilise scar area, desensitisation
Strength, flexibility and fitness specific to prosthetic use
Interim prosthesis
- Don & Doff socks & prosthesis
- Standing in prosthesis, gait training, functional retraining
- Adjustments/modification of prosthesis
Psychological support
What are 2 types of lower limb prosthesis?
Above the knee and foot prosthesis
What are 3 types of upper limb prosthesis?
Cosmetic/passive
Mechanical (cable controlled)
Myoelectric
