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Questions and Answers
What characterizes microvascular disease in diabetes?
What characterizes microvascular disease in diabetes?
What is a common risk factor for peripheral artery disease (PAD)?
What is a common risk factor for peripheral artery disease (PAD)?
What is the primary purpose of amputation?
What is the primary purpose of amputation?
What type of damage does macrovascular disease refer to?
What type of damage does macrovascular disease refer to?
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Which condition is NOT typically associated with the need for amputation?
Which condition is NOT typically associated with the need for amputation?
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What is one potential result of decreased blood flow due to PAD?
What is one potential result of decreased blood flow due to PAD?
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What causes the basement membrane to thicken in diabetes?
What causes the basement membrane to thicken in diabetes?
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What does compromised blood flow lead to in the context of amputation?
What does compromised blood flow lead to in the context of amputation?
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Who is at greater risk for needing an amputation due to inactivity?
Who is at greater risk for needing an amputation due to inactivity?
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Which of the following is a common cause for acquired amputation?
Which of the following is a common cause for acquired amputation?
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What is one of the factors that can lead to amputation in an adult?
What is one of the factors that can lead to amputation in an adult?
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Which condition is NOT typically associated with complications that may require amputation?
Which condition is NOT typically associated with complications that may require amputation?
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How does smoking affect the risk of amputation?
How does smoking affect the risk of amputation?
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What is a potential consequence of compromised circulation due to hypertension?
What is a potential consequence of compromised circulation due to hypertension?
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What kind of injuries might result in traumatic amputation?
What kind of injuries might result in traumatic amputation?
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Which situation could lead to an amputation in utero?
Which situation could lead to an amputation in utero?
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Which of the following is likely to cause diabetic foot infection?
Which of the following is likely to cause diabetic foot infection?
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What is one reason professional athletes might choose to undergo amputation?
What is one reason professional athletes might choose to undergo amputation?
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What is the primary function of a prosthesis?
What is the primary function of a prosthesis?
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What type of device is an orthosis?
What type of device is an orthosis?
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What is a key focus during the preoperative evaluation of an amputee?
What is a key focus during the preoperative evaluation of an amputee?
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What is the primary aim of the procedures described?
What is the primary aim of the procedures described?
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Which of the following is NOT a goal of medical management after amputation?
Which of the following is NOT a goal of medical management after amputation?
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What factor is NOT considered when determining the level of amputation?
What factor is NOT considered when determining the level of amputation?
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What does effective post-operative support for an amputee aim to achieve?
What does effective post-operative support for an amputee aim to achieve?
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What is the recommended approach for bandaging a residual limb?
What is the recommended approach for bandaging a residual limb?
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What complication is suggested to be addressed through muscle exercises or splinting?
What complication is suggested to be addressed through muscle exercises or splinting?
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What is the preferred method for preserving limb growth in children with congenital deficiencies?
What is the preferred method for preserving limb growth in children with congenital deficiencies?
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What condition is most likely to lead to bruising and increased risk of hematoma following surgery?
What condition is most likely to lead to bruising and increased risk of hematoma following surgery?
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What potential issue is associated with amputation if the epiphyseal plate is removed?
What potential issue is associated with amputation if the epiphyseal plate is removed?
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What should be ensured before early prosthetic fitting?
What should be ensured before early prosthetic fitting?
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What is a common characteristic of phantom limb pain?
What is a common characteristic of phantom limb pain?
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What differentiates surgical pain from phantom limb pain in the postoperative period?
What differentiates surgical pain from phantom limb pain in the postoperative period?
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What sensation might be felt in phantom limb sensation?
What sensation might be felt in phantom limb sensation?
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Which of the following theories explains phantom limb pain?
Which of the following theories explains phantom limb pain?
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What may happen if phantom limb pain persists six months post-surgery?
What may happen if phantom limb pain persists six months post-surgery?
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What type of medications might be used for managing phantom limb pain?
What type of medications might be used for managing phantom limb pain?
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What is telescoping in relation to phantom limb sensation?
What is telescoping in relation to phantom limb sensation?
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What symptoms are typically associated with phantom limb pain?
What symptoms are typically associated with phantom limb pain?
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Study Notes
Amputation
- Amputation is the removal/cutting of a body extremity or other 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
- Peripheral arterial disease (PAD)
- Diabetes mellitus
- Inactive individuals
- Hypertension
- Hyperlipidemia
- Smokers
Factors leading to amputation
- Diabetic foot infection or gangrene
- Cancerous bone or soft tissue tumors
- Severe limb injuries
- Circulation problems
- Congenital deformities of digits and/or limbs
- Extra digits and/or limbs
- Advanced cancers
- Bone infection (osteomyelitis)
- Traumatic amputation (vehicular accidents)
- Amputation in utero (amniotic band)
- Punishment/Torture
- Non-essential digit amputation in athletes for pain relief
Diabetes and Vascular Disease
- Chronic elevation of blood glucose levels damages blood vessels.
- Endothelial cells lining blood vessels don't depend on insulin, taking in more glucose, than normal.
- This thickens and weakens the basement membrane.
- More surface glycoproteins form.
- Microvascular disease (damage to small blood vessels) and macrovascular disease (damage to arteries) result.
Peripheral Arterial Disease (PAD)
- PAD is a progressive, atherosclerotic disease characterized by occlusion and stenosis.
- It mainly affects the lower extremities.
- Risk factors include advancing age, hypertension, dyslipidemia, and a sedentary lifestyle.
- Results in decreased blood flow, pain, functional impairments, tissue loss, gangrene, and amputation.
Aim of Amputation
- Return patients to maximum levels of independent function
- Ablation of diseased tissue (tumor or infection)
- Reduce morbidity and mortality (tumor or infection)
- Part of a reconstruction to produce a physiological end organ
Levels of Amputation
- Two factors are considered; circulation and functional usefulness.
- Different levels of amputation are categorized from shortest to longest.
- Detailed measurements are available for specific levels.
Aftercare
- Good bandaging to mold the stump into a conical shape for prosthesis acceptance.
- Avoid proximal compression of the limb.
- Prevent contracture (by splinting and/or muscle exercises).
- Early prosthetic fitting when the limb is healed.
Amputation in Children
- Usually for congenital limb deficiencies.
- Try to retain the limb if possible.
- Preserve length.
- Disarticulate, if possible, to prevent bony overgrowth (preserving growth potential).
Complications
- Hematoma (bruising)
- Infection
- Necrosis of stump end
- Contractures
- Neuroma (tumor-like growth on a nerve)
- Phantom pain (pain felt in the missing limb)
- Terminal overgrowth (children)
Pain
- Postoperative pain can be normal or phantom limb pain (burning, stinging, electric pain that increases with anxiety and stress).
- If pain persists six months after surgery, prognosis is unfavorable.
- Phantom limb sensation is the feeling that the absent limb is still present (itching, tickling, moving).
Phantom Limb Pain Theories
- Remaining nerves still generate impulses.
- Spinal nerves fire excessively without sensory input.
- Signal transmission and modulation in the somatosensory cortex is altered.
Pain Management
- First-line treatment: antidepressants and anticonvulsants.
- Other choices include N-methyl-D-aspartate antagonists, gabapentin, calcitonin, mexiletine, and opiates.
Telescoping
- Sensation that the distal part of the amputated extremity has moved proximally up the limb.
- Usually part of the nerve healing process and fades with time.
Prosthesis/Orthosis Terms
- Residual limb: the remaining part of the amputated limb.
- Terminal Device: The most distal part of the prosthesis.
- Myodesis: Direct suturing of muscle or tendon to bone.
- Myolplasty: Suturing muscles to the periosteum.
- Prehensile: Ability to grasp
Forequarter Amputations
- Removal of the upper limb with the scapula, mainly for malignancy.
- Shoulder disarticulation and proximal amputations are techniques used.
Above Elbow Amputations
- Equal anterior and posterior flaps are used.
- Muscles are divided 5 cm below the bony resection.
- Triceps muscle is sutured to anterior muscles.
Elbow Disarticulation
- Articular surface is left intact
- Flexor tendons are sutured to extensors.
- Flaps are closed over drains.
Below Elbow Amputations
- Length is preserved.
- Myoplastic closure or suturing of flexors to extensors is done.
Krukenberg Procedure
- Separation of radial and ulna rays to create pincers for strong prehension and manipulation.
Wrist Disarticulation
- Preserves forearm rotation.
- Flaps are created for length and prosthetic fitting.
Hand Amputations
- Preserve length, function, and sensation.
- Amputation can either be done from distal to PIPJ or from proximal to base MC (whole ray).
Pre-op Evaluation
- Tissue evaluation: feel pulses, skin temperature, level of dependent redness
- Doppler Ultrasound to check circulation (sometimes inaccurate with calcified blood vessels).
- Arteriogram
Preperative Care
- Control diabetes, evaluate cardiac, renal, cerebral circulation, and preoperative calorie control in malnourished patients.
- Counseling for pain management, return to function, and support groups.
- Pain clinic review (pain control/spinal anesthetic).
Medical Management
- Goal: non-tender & healthy residual limb for use with prosthesis
- Promote healing by preventing infection, careful handling, and control of edema.
Dressings
- Closed rigid dressing
- Removable rigid dressing
- Soft dressing (gauze bandages)
Psychological Support
- Need to grieve loss with support for permanent body image changes.
- This may involve anger, bitterness, hostility, denial, withdrawal, depression, and anxiety.
- Multidisciplinary rehabilitation teams are helpful for optimal functioning.
Plan/Goals
- Relief of pain
- Absence of sensory alteration
- Acceptance of altered body image
- Self-care independence
- Absence of complications
- Restoration / regaining physical mobility
- Healing of wounds
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Description
This quiz explores the causes and factors leading to amputation, including congenital and acquired conditions. It focuses on high-risk individuals and the relationship between diabetes and vascular disease. Test your knowledge on how various conditions can affect limb health and the rationale behind surgical interventions.