Chapter 3-Planning for Optimal Function in Amputation Surgery

Question 1

What is the best solution for painful dysvascular limbs?

Answer 1

Early amputation at the most distal level with rehabilitation with a prosthesis

Question 2

Why can’t diabetics have vascular reconstructive surgery?

Answer 2

They have small-vessel disease which is not treatable with vascular reconstruction

Question 3

In World War II, what was the majority of lower-limb amputations?

Answer 3

Transfemoral

Question 4

Energy expenditure increases due to what?

Answer 4

Level of amputation. 
Increase with increased height of amputation
Transtibial increase of 9%
Transfemoral 49%
Bilateral transfemoral 280%

Question 5

What is often indicated for geriatric bilateral amputees?

Answer 5

Wheelchair locomotion and transfemoral amputation to prevent flexion contractures of the knees

Question 6

What are clinical parameters to determine the distal most level of amputation?

Answer 6

Lowest palpable pulse
Skin temperature
Bleeding at surgery

Question 7

What are non clinical parameters for determining the distal level of amputation?

Answer 7

Doppler ultrasonography
Xe measurements
Transcutaneous Po2 measurement
Fluorescein angiography

Question 8

How do you measure transcutaneous Po2?

Answer 8

Warm skin to 44 degrees Celsius with a heated electrode

The electrode will then measure the oxygen emanating from the skin

Question 9

What factors cannot be assessed during the preoperative period?

Answer 9

Alteration in collateral circulation
Decreased distal vascular runoff
Surgical technique
Nutritional status 
Infection
Concomitant medical illnesses
Postoperative care

Question 10

What nutritional factor causes an adverse affect on morbidity and mortality in hospitalized patients?

Answer 10

Protein malnutrition

Question 11

What is the increased percentage of energy requirement due to trauma or infection?

Answer 11

30-55%

Question 12

What may increase the success rate of the amputation, if included in the preoperative stage?

Answer 12

Nutritional supplements

Start of antibiotics

Question 13

During the operative period, how should the soft tissue be handled for dysvascular patients?

Answer 13

In a nontraumatic manner

Tissue forceps should be avoided

Question 14

What is considered a long transtibial amputation length?

Answer 14

50% of the length of the remaining limb

Question 15

What is considered a medium transtibial amputation length?

Answer 15

20-50%

Question 16

What is considered a short transtibial amputation length?

Answer 16

less than or equal to 25%

Question 17

What soft-tissue management has been used to salvage a longer amputated limb?

Answer 17

Free-muscle transfers
Tissue expanders
Ilizarov technique

Question 18

Which type of limbs should not be closed right away following amputation?

Answer 18

Grossly contaminated traumatic wounds

Infected dysvascular limbs

Question 19

How do you avoid neuromas at the site of weight bearing?

Answer 19

Sharply divide the nerves and allow their retraction into sufficient soft-tissue cover

Question 20

What should occur in the immediate postoperative period after amputation?

Answer 20

Stumps should be splinted with well-padded rigid dressings to prevent joint contractures
IPOP- allow prosthetic ambulation

Question 21

What are the benefits of an IPOP?

Answer 21

Prosthetic ambulation
Decrease edema
Diminish postamputation depression

Question 22

Which type of patient benefit from IPOPs

Answer 22

Young traumatic amputees

Question 23

What are the downfalls of the IPOP?

Answer 23

Cause wound problems

Question 24

What should be considered prior to prosthetic fitting?

Answer 24

Impaired vision
Poor balance
Psychological problems
Additional musculoskeletal problems like RA