Amputations
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| show | -Early centuries:
-Amputations primarily from gangrene and war
-Most devices were designed as “peg legs”
-Present day:
-Major cause is Peripheral Vascular Disease (PVD)- 54%3
-PVD- diseases of blood vessels outside the heart and brain
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| show | -Present day:
-Trauma-related amputations (45%)
-MVC, gun shot wounds, & war
-Usually young men
-Tumors (<2%)
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| show | -2013> 2 million living with limb loss
~185,000 amputation/yr in US
-50% w/ amputation vascular disease die in 5 yrs
-55% of diabetics w/ LE amputation, require amputation of second leg in 2‐3 years
-Smokers- increased infection and re-amputation
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| Amputation statistics cont... | show 🗑
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| Measures to determine level of amputation through examining tissue viability | show 🗑
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| What is amputation | show 🗑
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| show | -Blood vessels
-Nerves
-Bones
-Muscles
-Skin
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| Hemostasis is achieved by | show 🗑
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| Cauterization is used for | show 🗑
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| show | -Not compromise circulation to distal tissues including skin flaps
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| Nerves | show 🗑
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| show | -Muscles stabilization to other tissues allows for max retention of function
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| show | -muscle to fascia
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| Myoplasty | show 🗑
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| Myodesis | show 🗑
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| show | -tendon to bone
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| show | -Left at a length to allow wound closure without excessive bone at the distal end of the RL
-Sharp bone ends are smoothed and rounded
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| show | -Tibfib bone bridge
-Facilitates natural bridging
-Better load bearing
-Better shaping
-Less muscle retraction
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| Skin flaps are left... | show 🗑
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| show | -Pilable, P!less, non-adherent
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| Long posterior flaps | show 🗑
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| show | -Diagonal scar for better blood circulation
-Medial lower leg more vascular than lateral
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| show | -Removal of part of toe(s)
-Won't affect function significantly
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| Toe disarticulation | show 🗑
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| Partial foot (more common) | show 🗑
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| show | -Removal just above the malleoli
-Ankle disarticulation
-No foot remains
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| Ankle amputation: Pirigoff | show 🗑
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| show | -Aka Below Knee Amputations (BKA)
-Sublevels (% of tibia remaining)
-Long- > 50%
-Standard- 20-50%
-Short- < 20%
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| Knee disarticulation | show 🗑
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| Transfemoral Amputations (more common) | show 🗑
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| show | -Most perf. either for tumors or severe trauma
-Represent a small percentage of the amputee population
-Disarticulation- through the joint
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| Hemipelvectomy | show 🗑
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| Hemicorporectomy | show 🗑
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| show | -Emergency (quick) amputation
-May precede secondary closure with skin flaps
-Occasionally, free tissue flaps, taken from some other area of the body, may be used to cover deformities
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| show | -Amputation in the presence of unclean tissue
-Secondary Intention healing
-Left open so the wound can be cleaned before closure
-Trying to decrease the chance of infection
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| show | -Swelling control/Increase venous return
-RL formation
-Prevent:
-Flesh role (superomedially)
-Flexion contractures
-Comfort
-Protection/hygiene
-Desensitization
-Proprioception with earlier walking
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| show | -Not removable
-Then there are Removable Rigid Dressings (RRD)
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| show | -Compression dressing
-100% cotton gauze
-Impregnanted with a non-hardening zinc oxide paste
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| Cont...post-op dressings | show 🗑
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| show | Properly tensed including…
… decreasing tension distal to proximal
… holding hip into extension/adduction with AKA
½ overlapped and void of circular turns and wrinkles
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| Soft dressing bandaging should be...cont... | show 🗑
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| show | -Apply dry bandage to dry RL
-Wear bandage at all times except for hygiene or treatment purposes
-Re-wrap every several hours (4-6 hrs.)
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| show | -Infection
-Smoking
-Severity of vascular problems
-DM
-Renal Disease
-Cardiac Disease
-Obesity
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| show | -Earlier rehab
-Longer > shorter RL
-Unilateral > bilateral amputation
-A well-healed, well-shaped RL without scar adhesions
-Younger age
-Insignificant PMH
-Compliance
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| Prognosis | show 🗑
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