Amputation and Risk Factors
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Questions and Answers

What characterizes microvascular disease in diabetes?

  • Damage to small blood vessels (correct)
  • Thickening of the arterial walls
  • Damage to large blood vessels
  • Formation of arterial plaques
  • What is a common risk factor for peripheral artery disease (PAD)?

  • Advanced age (correct)
  • Elevated cholesterol levels
  • High fiber diet
  • Increased fluid intake
  • What is the primary purpose of amputation?

  • To enhance physical appearance
  • To prevent all types of surgeries
  • To relieve symptoms and improve quality of life (correct)
  • To remove non-functional organs
  • What type of damage does macrovascular disease refer to?

    <p>Damage to larger arteries</p> Signup and view all the answers

    Which condition is NOT typically associated with the need for amputation?

    <p>Cardiovascular disease</p> Signup and view all the answers

    What is one potential result of decreased blood flow due to PAD?

    <p>Tissue loss and gangrene</p> Signup and view all the answers

    What causes the basement membrane to thicken in diabetes?

    <p>Excess glucose intake by endothelial cells</p> Signup and view all the answers

    What does compromised blood flow lead to in the context of amputation?

    <p>Necrosis of affected tissues</p> Signup and view all the answers

    Who is at greater risk for needing an amputation due to inactivity?

    <p>Individuals with sedentary lifestyles</p> Signup and view all the answers

    Which of the following is a common cause for acquired amputation?

    <p>Trauma</p> Signup and view all the answers

    What is one of the factors that can lead to amputation in an adult?

    <p>Severe limb injuries</p> Signup and view all the answers

    Which condition is NOT typically associated with complications that may require amputation?

    <p>Asthma</p> Signup and view all the answers

    How does smoking affect the risk of amputation?

    <p>It constricts blood vessels.</p> Signup and view all the answers

    What is a potential consequence of compromised circulation due to hypertension?

    <p>Need for amputation</p> Signup and view all the answers

    What kind of injuries might result in traumatic amputation?

    <p>Vehicular accidents</p> Signup and view all the answers

    Which situation could lead to an amputation in utero?

    <p>Amniotic band entanglement</p> Signup and view all the answers

    Which of the following is likely to cause diabetic foot infection?

    <p>Poor blood sugar control</p> Signup and view all the answers

    What is one reason professional athletes might choose to undergo amputation?

    <p>To relieve chronic pain</p> Signup and view all the answers

    What is the primary function of a prosthesis?

    <p>To replace the function or appearance of a missing limb or body part</p> Signup and view all the answers

    What type of device is an orthosis?

    <p>A device designed to supplement or augment an existing limb</p> Signup and view all the answers

    What is a key focus during the preoperative evaluation of an amputee?

    <p>Assessing limb circulation with Doppler ultrasound</p> Signup and view all the answers

    What is the primary aim of the procedures described?

    <p>To return the patient to maximum independent function</p> Signup and view all the answers

    Which of the following is NOT a goal of medical management after amputation?

    <p>Improve psychological adjustment of the patient</p> Signup and view all the answers

    What factor is NOT considered when determining the level of amputation?

    <p>Patient's age</p> Signup and view all the answers

    What does effective post-operative support for an amputee aim to achieve?

    <p>Independence of self-care and restoration of physical mobility</p> Signup and view all the answers

    What is the recommended approach for bandaging a residual limb?

    <p>Mold the stump into a conical shape to fit the prosthesis</p> Signup and view all the answers

    What complication is suggested to be addressed through muscle exercises or splinting?

    <p>Contractures due to muscle imbalance</p> Signup and view all the answers

    What is the preferred method for preserving limb growth in children with congenital deficiencies?

    <p>Disarticulation at joints</p> Signup and view all the answers

    What condition is most likely to lead to bruising and increased risk of hematoma following surgery?

    <p>Hemophilia</p> Signup and view all the answers

    What potential issue is associated with amputation if the epiphyseal plate is removed?

    <p>Bony overgrowth</p> Signup and view all the answers

    What should be ensured before early prosthetic fitting?

    <p>The limb has no contracture and is fully healed</p> Signup and view all the answers

    What is a common characteristic of phantom limb pain?

    <p>Burning or stinging sensation</p> Signup and view all the answers

    What differentiates surgical pain from phantom limb pain in the postoperative period?

    <p>Response to opioids</p> Signup and view all the answers

    What sensation might be felt in phantom limb sensation?

    <p>Itching or tickling</p> Signup and view all the answers

    Which of the following theories explains phantom limb pain?

    <p>Excessive nerve impulse generation</p> Signup and view all the answers

    What may happen if phantom limb pain persists six months post-surgery?

    <p>The prognosis is unfavorable</p> Signup and view all the answers

    What type of medications might be used for managing phantom limb pain?

    <p>Antidepressants and anticonvulsants</p> Signup and view all the answers

    What is telescoping in relation to phantom limb sensation?

    <p>The sensation of the distal part moving proximally</p> Signup and view all the answers

    What symptoms are typically associated with phantom limb pain?

    <p>Burning or stinging sensations</p> Signup and view all the answers

    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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    Related Documents

    Amputation PDF

    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.

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