Amputations Flashcards
Functional limb
Muscles
Bones
Tendons
Nerves
Blood vessels
Indications for amputations
Peripheral vascular disease
Trauma
Compartment syndrome
Infection
Tumours
Deformities
Perioperative evaluation and preparation
Patient selection
Medical risk
Psychological evaluation
Antibiotics
Thromboprophylaxis
Level of amputation
8 lower limb amputation
Considerations made before an amputation
Major (above the ankle), minor (below the ankle)
Primary (No attempt at limb salvage), Secondary (failed limb salvage)
Priorities( Life over limb)
Deciding on the level of amputation.
Clinical (demarcation, functional status, physiological reserves)
Radiological (CTA, Doppler)
Adjuncts (Tcp02, thermography, skin perfusion pressure, dyes)
Stability
Big toe bares most of the weight of the body
First metatarsal is the insertion of ankle stabilisers
NB muscles: Tibialis anterior and posterior, peroneal longus and brevis
Maintain weight bearing triangle to maintain balance.
Important to maintain foot arch.
Minor amputations
Toe-ectomy
For disease isolated to the toe
Low morbidity
Good mobilisation
Technically easy
Minor amputations
Trans-metatarsal
Includes ray amputations.
Good wound healing rates.
Patient still able to mobilise
Low morbidity.
Minor amputation
Lisfranc: tarsometatarsal
Chopart: Transtarsal
Both historical:
equinus and equinavarus deformities
Difficulties with prosthesis.
Difficult mobilisation
Minor amputations
Symes amputation
Through the ankle joint
Also historical
Patient can mobilise with good
rehabilitation
Major amputations
BKA(below knee amputation).
Also called trans tibial.
Technically more challenging
Than an aka
80% wound healing rate
Requires less energy for
Prosthesis mobilisation
Major amputations
Through knee amputation
Performed less frequently
Than bka and aka
Technically challenging
Good alternative to an aka
Disproportionate prosthesis
Joint to contralateral joint
Major amputations
AKA(above knee amputation)
Good wound healing rate of 90%
Higher mortality rate than BKA
Requires more energy for prosthesis
Major amputations
Hip disarticulation
50% mortality rate.
Should be avoided if possible
Difficult to fashion a functional prosthesis
Upper limb amputations
Performed less frequently than lower limb
Technically more challenging
Good wound healing
Loss of fine motor function
Difficult to fashion prosthesis
