Amputations : Amputations Donna priya.J Amputation- Definition : Amputation- Definition Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. Types of amputation : Types of amputation UPPER LIMB:
amputation of digits
forearm amputation (transradial)
above-elbow amputation (transhumeral)
shoulder disarticulation and forequarter amputation
Krukenberg procedure Slide 5: LOWER LIMB:
amputation of digits
partial foot amputation (Chopart, Lisfranc, Ray)
ankle disarticulation (Syme, Pyrogoff)
below-knee amputation (transtibial e.g. Burgess, Kingsley Robinson)
knee-bearing amputation (knee disarticulation, e.g. Gritti or Gritti-Stokes)
above knee amputation (transfemoral)
Van-ness rotation/rotationplasty (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
hemipelvectomy/hindquarter amputation Factors leading to an amputation : Factors leading to an amputation Diabetic foot infection or gangrene
Cancerous bone or soft tissue tumours
Severe limb injuries in which the limb cannot be spared or attempts to spare the limb have failed
Congenital deformities of digits and/or limbs
Extra digits and/or limbs
Any advanced cancers
Bone infection (osteomyelitits)
Traumatic amputation Risks Factors : Risks Factors Peripheral arterial disease (PAD)
Hyperlipidemia Diabetes and vascular disease : Diabetes and vascular disease Chronic elevation of blood glucose level leads to damage of blood vessels.
The endothelial cells lining the blood vessels don`t depend on insulin and take in more glucose than normal.
It causes the basement membrane to grow thicker and weaker.
They then form more surface glycoproteins than normal
In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries). Prevention : Prevention Screening
Monitor blood glucose levels
Use insulin as prescribed or as PRN
Maintain an adequate diet Peripheral Arterial Disease : Peripheral Arterial Disease PAD is a progressive atherosclerotic disease characterized by occlusion and stenosis.
It most often involves the arteries of the lower extremities
Risk factors include advancing age, hypertension, dyslipidemia (elevation of cholesterol), and sedentary lifestyle.
Results in decreased blood flow to the legs and feet resulting in pain, functional impairments, tissue loss, gangrene and amputation Prevention of Peripheral Arterial Disease : Prevention of Peripheral Arterial Disease 1)Positioning the extremity below the level of the heart
2)Walking or other moderate or graded isometric exercises.
3)Arterial dilation promotes increased blood flow to the extremities
5)Reduce emotional upsets
6) Avoid constrictive clothing and accessories Complications of Amputation : Complications of Amputation Hemorrhage
Phantom limb pain
Phantom limb sensation
Stump Neuroma Management : Management Goal: non-tender & healthy residual limb for prosthetic use.
Promote healing: - careful handling - controlling edema - preventing infection Stump Evaluation : Stump Evaluation Shape
Appearance of stump
length of bone
length of stump
Scar Slide 18: Skin : dry.
Phantom limb pain :
Phantom limb sensation :
Stump neuroma .
Temperature Slide 19: T/C/D
Muscle tone in residual limb.
Range of motion
Home envt and Comm, evaluation
Emotional status Slide 20: Emotional level– psychological support for the client and family.
Prepare client for therapy.
Instruction in proper hygiene of the limb. Initial phase Checkouts of prosthesis : Checkouts of prosthesis Is checked for Fit and Function against sp. Mechanical standards
ROM with the prosthesis on and off
Control system function and Efficiency
Terminal device opening in various positions
Slippage of socket in various degrees of load and tension
Compression and fit Below elbow prosthesis : Below elbow prosthesis Tpt measures Elbow flexion, TD opens fully in 90 deg of elbow flex.
Full elbow flex. And ext. – TD opens
ROM should not differ more than 10 deg.
Pronation and supination with the prosthesis should not be less than 50% of rotation without the prosthesis Above elbow and Shoulder prosthesis : Above elbow and Shoulder prosthesis Elbow locked on using the residual limb
Shoulder ROM is measured in: 90 deg flex., 30 deg ext.
90 deg abd., 45 deg rotation.
When elbow is unlocked, shoulder flexion is done slowly,
it flexs the mech. Elbow movt-10 to 135 deg
Shoulder flexion should not exceed more than 45 deg.
90 deg of elbow flex. And the pt locks the elbows. Full TD should open
Elbows unlocked the pt practices swinging of arms Slide 24: Residual limb shrinkage and shaping.
(cylindrical to conical shape)
Residual limb desensitization.
Promote wound healing
Maintenance of normal joint range of motion
Increasing muscle strength
Orientation to prosthetic options. PRE PROSTHETIC TRAINING GOALS Slide 25: Reducing phantom limb pain and sensation.
Maintaining proper hygiene of the limb
To improve Endurance
Understanding the prosthetic components
Improve body image, self image, and psychological adjustment
Improve skin hygiene Slide 26: Wrapping of residual limbs Prosthetic training : Prosthetic training Independence in donning and doffing the prosthesis.:
Coat and Sweater method
Orientation to a wearing schedule,
Control of prosthesis is trained
Promote positive proper body image
Care of the residual limb and prosthesis.
Independence in all ADL tasks.
Exploration of patient goals regarding the future.
Community reintegration. Slide 28: Ambulation using prosthesis : simulation in the department.
Establish a home activity programs
Training them in different types of transfers
Such as Floor transfers, Pivot, Direct transfers