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Presentation Transcript

amputation : 


Conditions which may lead to amputation of a limb : 

Conditions which may lead to amputation of a limb Peripheral Arterial occlusive disease Acute occlusion due to embolism Aneurysm Diabetic limb disease Nectrotising fasciitis Trauma

Signs and Symptoms : 

Signs and Symptoms Pain due to reduced perfusion often relieved by lowering the limb Absence of pulse popliteal, dorsalis pedis Skin changes; temperature, hairless, flaky, ulcerated, shiny Blue/black discolouration, necrosis of toes/foot Anaerobic infection aeromonas hydrophylia – ‘gas gangrene’

Treatment Options : 

Treatment Options Angiogram-angioplasty Sympathectomy Insertion of bypass graft Removal of affected toes or partial foot amputation Below through or above the knee amputation

Surgical Management of Amputation : 

Surgical Management of Amputation Aim: to provide useful, functional, well moulded, healthy stump Total excision of diseased tissue Maintenance of sufficient blood supply to allow healing

Pre-op Care : 

Pre-op Care Standard pre-op care applies including Chest x-ray ECG FBC U&E’s Glucose Blood group and saved Lower foot of the bed, pain control (opiates, NSAID, epidural) Odour absorbent dressing on necrotic areas Counselling and support Prepare by introducing other members of the team, possibly an amputee who has coped well with the surgery Looking after relatives, involve when appropriate

Post-op Care : 

Post-op Care Standard Post-op Care Specific: Insert a bed cage to minimise pressure, with stump in neutral position Pain: 3 sources; wound pain, back pain and phantom pain Wound pain can be controlled with opiates in the immediate phase and if needed, NSAID’s used

Actual and Potential Problems : 

Actual and Potential Problems Contracture of joints: keep stump prone Ischaemia: poor perfusion, infection, wound breakdown, pain Flap tension: tightness of skin over bone causing tension in the wound Oedema: due to tissue damage, dependence and poor venous drainage Infection: high risk due to ischaemia, particularly diabetic patients, poor healing Poor stump management (moulding)

Body Image : 

Body Image Potentially greater psychological impact Patient more likely to have been younger and fitter Socialisation issues, feeling of inadequacy Sexuality: body reality-body ideal and body presentation Patients need to come to terms with clothing issues i.e. tucking sleeve in pocket

Phantom Pain : 

Phantom Pain A phenomenon which sees the patient experiencing pain in the missing limb, which can last for months post op. TENS machine has been shown to aid this pain Local nerve blocks Longer term use of carbimazapine Relaxation / complimentary therapy

Rehabilitation and Discharge : 

Rehabilitation and Discharge Involvement of the multidisciplinary team is essential Physiotherapist for mobility, provision of stump board or wheelchair OT for home assessment and safety issues Social work, benefits, mutability car etc District nurses for wound checks Involvement in local amputee groups Medical follow up at out patient clinic

Traumatic AmputationCare of the Stump or Wound : 

Traumatic AmputationCare of the Stump or Wound Generously irrigate with warmed, sterile saline to remove gross contamination DO NOT scrub or use povidine iodine, hydrogen peroxide or soaps Apply sterile moistened gauze and light pressure bandage if bleeding Elevate above the level of the heart If amputation incomplete, apply a splint and cool devascularized portion of the extremity with indirect ice packs and elevate.

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