Amputation and Its Risk Factors

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Questions and Answers

What is one purpose of amputation?

To prevent aging

To eliminate pain completely

To relieve symptoms and improve quality of life (correct)

To enhance athletic performance

Which of the following conditions is NOT a risk factor for amputation?

Hypertension

Asthma (correct)

Peripheral arterial disease (PAD)

Diabetes mellitus

What can lead to amputation in individuals with severe limb injuries?

Aesthetic reasons

Preference for prosthetics

Successful attempt to save the limb

Severe circulation problems (correct)

What is one reason a professional athlete might choose to undergo amputation?

To relieve chronic pain and improve performance Signup and view all the answers

Which of the following contributes to the necessity for amputation due to infection?

Bone infection (osteomyelitis) Signup and view all the answers

What congenital condition can necessitate amputation?

Amniotic band syndrome Signup and view all the answers

Which of the following is NOT a type of amputation mentioned in the content?

Planned ablation Signup and view all the answers

Which type of tumor could lead to amputation?

Advanced cancerous bone or soft tissue tumors Signup and view all the answers

Which method is used to assess limb circulation during a preoperative evaluation?

Doppler ultrasound Signup and view all the answers

What is a key psychological aspect to address preoperatively in patients undergoing amputation?

Grieving the loss of the limb Signup and view all the answers

What is one of the primary goals for medical management after an amputation?

Promoting a non-tender and healthy residual limb Signup and view all the answers

Which of the following dressing types is designed to be removed for evaluation or care?

Removable rigid dressing Signup and view all the answers

What is a major concern that must be addressed in the postoperative care plan?

Absence of complications Signup and view all the answers

What leads to the damage of blood vessels in diabetes?

Chronic elevation of blood glucose levels Signup and view all the answers

What characterizes peripheral artery disease (PAD)?

Stenosis and occlusion of arteries Signup and view all the answers

Which of the following is a risk factor for peripheral artery disease?

Advancing age Signup and view all the answers

What results from chronic damage to small blood vessels in diabetes?

Microvascular disease Signup and view all the answers

What effect does peripheral artery disease have on the legs and feet?

Functional impairments and pain Signup and view all the answers

What is one of the aims of treating tumors or infections in the context of amputation?

Reduce morbidity and mortality Signup and view all the answers

Why is good bandaging important after an amputation?

To mold the stump into a conical shape Signup and view all the answers

What two factors are considered in the levels of amputation?

Circulation and functional usefulness Signup and view all the answers

What is myodesis?

Direct suturing of muscle or tendon to bone Signup and view all the answers

What is the primary purpose of a terminal device in a prosthesis?

Perform tasks through grasping or holding Signup and view all the answers

What characterizes forequarter amputation?

Removal of the upper limb with the scapula Signup and view all the answers

How does elbow disarticulation compare to humeral amputation?

Allows better suspension but poorer cosmesis Signup and view all the answers

What is a key consideration in performing below elbow amputations?

Maximizing the length of the residual limb Signup and view all the answers

What distinguishes a prosthesis from an orthosis?

A prosthesis replaces body functions, whereas an orthosis enhances them Signup and view all the answers

What is the primary goal for thumb amputations?

Preserve length, stability, and sensation Signup and view all the answers

What does the Krukenberg procedure aim to achieve?

Form strong prehensile pincers from the radial and ulna rays Signup and view all the answers

What is a common theory explaining phantom limb pain?

The remaining nerves continue to generate impulses. Signup and view all the answers

Which of the following is NOT a complication associated with amputation?

Bone regeneration Signup and view all the answers

Which technique is recommended to preserve limb length in children?

Disarticulation Signup and view all the answers

How is phantom limb sensation characterized?

Itching or tickling sensations Signup and view all the answers

What treatment is often first-line for managing phantom limb pain?

Antidepressants Signup and view all the answers

What condition must be distinguished from normal postoperative pain?

Phantom limb pain Signup and view all the answers

What is indicated by telescoping in amputees?

Sense of limb shrinkage. Signup and view all the answers

Which treatment can be of some success in managing phantom limb pain?

Opiates Signup and view all the answers

Study Notes

Amputation

Amputation is the removal or cutting of a body extremity or part.
It can be congenital or acquired (traumatic, ischemic, or surgical).
It's used to relieve symptoms, improve function, and improve the patient's quality of life.

Individuals at Risk

Individuals with peripheral arterial disease (PAD)
Individuals with diabetes mellitus
Inactive individuals
Individuals with hypertension
Individuals with hyperlipidemia
Smokers

Factors Leading to Amputation

Diabetic foot infection or gangrene
Cancerous bone or soft tissue tumors
Severe limb injuries that cannot be spared or attempts to spare have failed
Circulation problems
Congenital deformities of digits or limbs
Extra digits or limbs
Advanced cancers
Bone infection (osteomyelitis)
Traumatic amputation
Utero amputation (amniotic band)
Punishment/torture
Sometimes professional athletes may choose amputation to relieve chronic pain and impaired performance

Diabetes and Vascular Disease

Chronic elevation of blood glucose levels leads to blood vessel damage.
Endothelial cells in blood vessels take in more glucose than normal.
This causes the basement membrane to thicken and weaken, leading to more surface glycoproteins than normal
This results in micro and macrovascular disease.

Peripheral Arterial Disease (PAD)

Progressive atherosclerotic disease characterized by occlusion and stenosis of arteries (mostly in the lower extremities).
Risk factors include advancing age, hypertension, dyslipidemia (high cholesterol), and a sedentary lifestyle.
Results in decreased blood flow to the legs and feet. This leads to pain, functional impairments, tissue loss, gangrene, and amputation.

Aim of Amputation

Return patient to maximum level of independent function.
Ablation of diseased tissue (tumor or infection).
Reduce morbidity and mortality related to the condition.

Levels of Amputation

Factors considered include circulation and functional usefulness.
Specific levels of amputation are detailed with descriptions of the optimum, shortest, and longest section for various limb locations.

Types of Amputation Procedures

Procedures such as Intrascaquiothoracis, Shoulder Disarticulation, Proximal Amputation, Elbow Amputations are described and outlined
Detailed procedures for Elbow, and Below Elbow Amputations are described.

Aftercare

Good bandaging for stump moulding into a conical shape for prosthetic fit.
Avoid proximal compression of limb.
Prevent contracture issues by splinting or muscle exercises.
Early prosthetic fitting as possible.

Children

Usually for congenital limb deficiencies.
Try to retain the limb if possible to preserve length for growth potential.
Disarticulate if possible to prevent bone overgrowth from trans-diaphyseal amputation.

Complications

Haematoma
Infection
Necrosis of the stump end
Muscle imbalance leading to contractures
Neuroma at nerve ending
Phantom pain
Terminal overgrowth (children)

Pain

Distinguish between normal postoperative pain and phantom limb pain.
Surgical pain often responds well to opioids.
Phantom limb pain usually described as burning, stinging, electric pain and is often worsened by stress and anxiety.
If phantom pain persists at six months post-surgery, prognosis is generally unfavorable.

Phantom Limb Sensation

This is distinct from pain.
Patients describe sensations of an amputated limb, such as itching, tingling or movement.
They often don't produce painful sensations.

Phantom Limb Pain Theories

There are three main theories about phantom limb pain
Continued impulse generation by remaining nerves
Excessive spinal cord nerve firing in absence of sensory stimuli from the limb.
Altered signal transmission and modulation in the somatosensory cortex.

Pain Management (Mx)

First-line treatment involves antidepressants and anticonvulsants.
N-methyl-D-asparate antagonists, gabapentin, calcitonin, mexiletine, and opiates are some other effective options in some cases.

Telescoping

Sensation that the distal part of the amputated limb has moved proximally.
Often a normal part of the nerve healing process that fades with time.

Prosthetics

Prosthesis replaces the function or appearance of a missing limb.
Orthosis supplements or augments function of an existing limb.

Pre-operative Evaluation

Tissue evaluation: clinical check of pulses, skin temperature, level of dependent redness, blood vessel circulation assessment with Doppler ultrasound (potentially inaccurate if vessels are calcified).
Arteriogram (imaging of arteries).

Pre-operative Considerations

Control for diabetes and other conditions such as cardiac and renal issues.
Evaluate the patient's nutritional status pre-operatively and make any required adjustments for calorie intake and blood sugar management.
Plan a return to function plan.
Preoperative counselling and amputee support groups.
Pain clinic review
Spinal anaesthesia.

Medical Management

Goal is to promote healing to create a non-tender and healthy residual limb to prepare for prosthetic use.
This includes carefully handling the limb, managing edema, and preventing infection.

Types of Dressings

Closed rigid dressing
Removable rigid dressing
Soft dressing

Psychological Support

Allow time for grief related to loss and body image changes.
Help patients cope with potential feelings such as anger, hostility, denial, withdrawal, depression, and anxiety.
Support groups and multidisciplinary teams provide assistance through these initial phases.
Help clients achieve optimal functioning in the long-term.

Plan for Success

Relief of pain
Absence of altered sensory perceptions
Acceptance and adjustment to altered body image
Independent self-care
Absence of complications
Restoration of physical mobility
Wound healing process needs to be monitored and addressed.

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Description

This quiz explores the concept of amputation, its causes, and the individuals at risk. It covers congenital and acquired reasons for amputation, as well as conditions that predispose patients to this surgical procedure. Test your knowledge on how amputation can impact quality of life.