Amputation Flashcards
(31 cards)
limb salvage
depending on severity part of foot may be kept
eg just amputate toes/partial foot
depends on boundaries of dead tissue, prosthesis use, mobility/function, cosmetic appearance
myodesis
muscle secured to bone by suturing distal tendon drilled into bone
done in amputation bka/aka to reduce residual limb deformity
myoplasty
attach muscle to opposing muscle
indications for amputation
PVD
diabetic wounds
trauma
infection
cancer
congenital deformity
fall prevalence in amputees
50% of those using prosthetic fall at least once per year
what contributes to worsened balance/increased fall risk after amputation
lose somatosensory input
reduced weight bearing
reduced confidence
loss of ankle strategy necessitates increased reliance on other balance strategies
reduced response to perturbation due to lack of kinesthetic awareness
symes amputation
remove foot, med/lat malleoli removal, relocate heel pad to distal tibia
chopart amputation
removal of foot distal to talus/calcaneus
lisfranc amputation
removal of foot distal to tarsometarsal joint
characteristics of BKA gait
decreased velocity
short step length
increased stance, especially on sound limb creating asymmetrical stance time
due to loss of mm. control in lower limb
characteristics of AKA limb control
loss/impaired musculature below pelvis
hip preserved
UE amputations types
interscapular thoracic: entire UE/clavicle/scapula
shoulder disarticulation: entire UE through shoulder joint
transhumeral: through humerus
elbow disarticulation: through elbow joint
transradial: through radius/ulna
wrist disarticulation: through wrist, removing carpals
partial hand/metacarpal/thumb/phalangeal removal
most often from trauma or cancer
amputation rehab timeline
pre op
surgery
acute post op: wound healing/control pain/strength/ROM
pre prosthetic: limb shaping, manage edema, address any impairments before prosthetic
determine candidacy for prosthetic
prosthetic training: static and dynamic use
community reintegration
return to work
functional follow up throughout lifetime
post op amputation rehab goals
wound healing
pain management, desensitization
ROM, avoid contractures
strength
protection
functional ADLs, transfers
ambulation
education
amputee PT examination includes:
integumentary: residual limb
vascular: pulse, edema, etc of both limbs
neuro: sensation, phantom limb, pain
shape: cylinder is ideal, may be bulbous, dog eared
MSK: ROM, strength, contractures
vitals
functional mobility
gait
cognition
psych state
pain management after amputation
phantom limb: perceive pain/tingling in missing limb
more in women>men
manage w meds, compression, relaxation, massage, biofeedback, TENS
measure limb length
include soft tissue
take from bony landmarks to incision line or end of soft tissue
use greater troch or ischial tub
ideal residual limb measurements
want distal circumference within 1/4 in of proximal limb circumference
contraindications to post op amputee PT
excess wound drainage
sharp local pain
fever
foul odor/infection
hold until stable
considerations:
cognitive dysfunction, comorbidities, CV, ulcer/infection, flexion contracture, age, psychosocial factors
compression dressings: ACE wrap
BKA: 4-6 in
AKA: 6 in
figure 8 pattern for edema control, easy to access wound
not very protective, needs to be reapplied, contractures
compression dressings: shrinker
elastic compression sock
custom sizing
controls edema, easy wound access, even compression
may not be comfortable, not protective, contractures
compression dressings: rigid dressing
plaster/rigid, place 7-10 days or removable
protects limb, prevent contractures
high infection risk if nonremovable bc decreased wound access, bulky and heavy
IPOP
rigid dressing with stick for ambulation
control edema, protect, shape limb
no incision access, expensive, training
AMPPro and AMPNoPro MDC
3.4 points
can be tested with or without prosthetic
AMPNoPro successful scores can indicate readiness for prosthetic
