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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 metacarpal amputation wrist disarticulation forearm amputation (transradial) elbow disarticulation above-elbow amputation (transhumeral) shoulder disarticulation and forequarter amputation Krukenberg procedure

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LOWER LIMB: amputation of digits partial foot amputation (Chopart, Lisfranc, Ray) ankle disarticulation (Syme,[3] 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.) hip disarticulation 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 Circulation problems 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) Diabetes mellitus Smokers Hypertension 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 4)Quitting smoking 5)Reduce emotional upsets 6) Avoid constrictive clothing and accessories

Complications of Amputation : 

Complications of Amputation Hemorrhage Infection Skin breakdown Joint contracture 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 : length of bone length of stump Stump circumference Scar

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Skin : dry. sensitive. Phantom limb pain : Phantom limb sensation : Stump neuroma . Colour change Temperature

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T/C/D Muscle tone in residual limb. Muscle power Range of motion Hand functions Functional abilities ADL Home envt and Comm, evaluation Emotional status

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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

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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 Maximizing independence Orientation to prosthetic options. PRE PROSTHETIC TRAINING GOALS

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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

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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. Vocational resettlement. Community reintegration.

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Ambulation using prosthesis : simulation in the department. Driving Modifications Establish a home activity programs Training them in different types of transfers Such as Floor transfers, Pivot, Direct transfers

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