Chapter 119 - UE disease - amputation

Question 1

percentage of amputations that are UE

Answer 1

10-25%

Question 2

Percentage of amputations that are fingers or wrist

Answer 2

93%

Question 3

Causes of UE amputations

Answer 3

Trauma 80-90% Vascular disease 7% Tumour 0.6%

Question 4

Reasons that UE amputations in trauma are less common than in LE

Answer 4

1) LE increase infection and non union 2) blast injury worse in LE 3) higher threshold for UE amputation due to lack of functional prosthetics

Question 5

Rate of amputation after attempted salvage in military trauma

Answer 5

10%

Question 6

Healing cutoff used for UE perfusion minimum

Answer 6

Digit pressure > 40 mmHg Wrist pressure > 60 mmHg tcPO2 > 40 mmHg

Question 7

Benefit of free flap over pedicled flap in UE

Answer 7

1) better matching of tissue 2) avoid additional surgery to thin flap 3) Lack of joint limitation

Question 8

Neuroma key points in UE

Answer 8

1) Difficult to prevent 2) Divide nerve far from external stimuli 3) early post-op therapy for sensory re-education

Question 9

Tried strategies for preventing UE neuroma

Answer 9

1) proximal or distal ligation 2) coagulation 3) chemical ablation 4) simple or traction division 5) attach to other nerves 6) immediate burrial

Question 10

Myodesic definition

Answer 10

Suture tendon or muscle to bone

Question 11

Myoplastic definition

Answer 11

Suture tendon or muscle to opposite functional group

Question 12

Principle of tendon repair with myodesic or myoplastic in UE

Answer 12

Ok in above wrist but not ok in fingers –> will lose functionality

Question 13

Composite reattachment definition

Answer 13

Reattach without specific revascularization

Question 14

Composite reattachment in UE

Answer 14

1) poor results 2) only done in < 2 year of age

Question 15

Finger amputation key points

Answer 15

1) if insertion of flexor + extensor digitorum compromised then disarticulation 2) Quadriga effect: if flexor sew to extensor then weaker grip 3) keep enough bone to support nail bed 4) secondary intent closure is ok if < 1 cm^2 5) nerve divided 1cm from tip

Question 16

Local flap closure of hand types

Answer 16

1) Kutler flap: lateral V-Y flap to close central tip defect 2) Atasoy flap: palmar V-Y flap 3) Palmar flap: soft tissue above tendon sheath elevated and advanced 4) Radius/ulnar flap: local flaps then STSG to donor site

Question 17

Problem with local flaps in UE

Answer 17

joint stiffness due to obligatory immobility

Question 18

Proximal phalanx amputation

Answer 18

Stump not functional but keep until patients want ray amputation

Question 19

Ray amputation technique in finger

Answer 19

Longitudinal dorsal incision over metacarpal and palmar over proximal phalanx or Racket incision

Question 20

Finger ray amp reduces palm size by this much

Answer 20

20-25%

Question 21

Thumb function is this much of total hand function

Answer 21

40%

Question 22

Pollicization definition

Answer 22

Reconstruct proximal thumb amputation using index, osteoplasty, bone lengthen, toe to thumb transfer

Question 23

Wrist amputation technique

Answer 23

1) Disarticulation 2) Long palmer, short dorsal flap 3) Nerve retraction (superficial branch of radial, brachial cutaneous nerve

Question 24

Ilizarov technique

Answer 24

Distraction osteogenesis

Question 25

Forearm amputation location

Answer 25

Joint of distal 1/3 to mid 1/3

Question 26

Krukenberg procedure

Answer 26

Pincer between radius and ulnar

Question 27

Indication for Krukenberg procedure

Answer 27

1) Bilateral injury 2) Blind 3) prosthetic not practical

Question 28

Site of transhumeral amp

Answer 28

4 cm proximal to elbow to accommodate for prosthetic joint

Question 29

Ways to lengthen stump

Answer 29

1) Ilizarov technique 2) fibular flap 4) free flap

Question 30

Techniques in shoulder disarticulation

Answer 30

1) Berger Anterior approach 2) Littlewood posterior approach differ in exposure of vascular structure behind clavicle

Question 31

Rate of infection UE amp

Answer 31

5%

Question 32

Failure of flap/reconstruction in UE amp

Answer 32

3-8%

Question 33

Revision rate for UE amp

Answer 33

42%

Question 34

Phantom pain in UE amp

Answer 34

40-50% worse in dominant hand

Question 35

Psych issues after UE amp

Answer 35

30-40%

Question 36

Rehab principle in UE amp

Answer 36

1) tissue shrink/shape 2) desensitization 3) increase ROM 4) skin health and mobility 5) muscle strength 6) augment independence 7) prosthetic options

Question 37

Types of prosthetics for UE amp

Answer 37

1) Aesthetic prosthetic 2) body-powered prosthetic 3) myoelectrically control prosthetic

Question 38

Hand transplant cases so far

Answer 38

70 cases between 1964 - 2013

Question 39

% of patients that do not want prosthetic after UE amp

Answer 39

40%

Question 40

Functional employment after UE amp

Answer 40

70% if college education 23% without

Question 41

Forearm amputation anatomy and crosssection

Answer 41

Question 42

Upper arm amputation anatomy and crosssection

Answer 42

Question 43

Shoulder disarticulation anatomy

Answer 43