Angiosomes and Arterial Supply Quiz
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Questions and Answers

What are some indications for lower extremity amputations?

  • Better cosmesis (correct)
  • No weight-bearing surface
  • Higher energy consumption
  • Decreased sensory input

Which of the following is NOT a reason for distal limb salvage as opposed to amputation?

  • decreased sensory input (correct)
  • Less distortion of body image
  • Enhanced lifestyle
  • Better weight-bearing surface

According to Attinger and Brown, what is a crucial consideration for successful limb salvage?

  • Achieving a functional prosthesis fit
  • Controlling infection
  • Ensuring good blood flow
  • Creating a stable soft tissue envelope (correct)

What does Malone suggest about the tissue to be removed during amputations?

<p>Necrotic, painful, or infected tissue should be left behind (B)</p> Signup and view all the answers

Which factor must be sufficient at the level of the proposed amputation for primary skin healing to occur?

<p>Blood supply (D)</p> Signup and view all the answers

What is a common reason for considering an amputation in cases of Charcot deformity?

<p>Control of chronic infection (C)</p> Signup and view all the answers

What is the primary purpose of leaving intrinsic muscle stability around the metatarsal phalangeal joint?

<p>To maintain joint stability and function (A)</p> Signup and view all the answers

What is the rationale for performing resection at the proximal metaphysis?

<p>To allow for closure over raw cancellous bone (B)</p> Signup and view all the answers

Which of the following is NOT an indication for a ray resection procedure?

<p>Gangrene of one or more toes and associated metatarsal (A)</p> Signup and view all the answers

What was the likely reason for the 59-year-old patient with psoriasis and a kidney transplant to undergo toe amputation?

<p>Verruca of the 4th digit (B)</p> Signup and view all the answers

What is the primary goal of a transmetatarsal amputation?

<p>To remove gangrene of the toes and associated metatarsal (C)</p> Signup and view all the answers

Which of the following is NOT a key factor in determining the need for a transmetatarsal amputation?

<p>Acute infection of the metatarsalphalangeal joint (B)</p> Signup and view all the answers

Which artery supplies the lateral ankle and plantar heel?

<p>Peroneal artery (D)</p> Signup and view all the answers

What is the surgical element that is recommended for stabilizing hindfoot fusions for long-term success?

<p>Steinman pin or K-wires (D)</p> Signup and view all the answers

How many angiosomes does the foot have?

<p>6 (D)</p> Signup and view all the answers

In cases of diabetes mellitus with chronic ulcers and osteomyelitis, which surgical intervention is usually not considered as a treatment option?

<p>Screws (B)</p> Signup and view all the answers

Which condition warrants insertion of antibiotic-contaminated tissue according to the text?

<p>Charcot arthropathy (C)</p> Signup and view all the answers

Which artery supplies the medial plantar instep?

<p>Posterior tibial artery (C)</p> Signup and view all the answers

What surgical procedure is mentioned as necessary for stability and function 3 years later after a specific case study?

<p>Fusing the ankle and subtalar joint (D)</p> Signup and view all the answers

What is the most important factor to consider for amputation level?

<p>Ambulatory status (C)</p> Signup and view all the answers

Which artery continues on to the dorsum of the foot as the dorsalis pedis?

<p>Anterior tibial artery (B)</p> Signup and view all the answers

In the context of limb salvage, what surgical consideration is emphasized in the article by Boyd, H.R. from October 1939?

<p>Calcaneotibial Arthrodesis (C)</p> Signup and view all the answers

What is the primary purpose of determining the level of adequate blood flow when considering the amputation level?

<p>To predict the success of wound healing (D)</p> Signup and view all the answers

What is the current state of predicting healing based on vascular status?

<p>It is still speculative and ongoing research is needed (C)</p> Signup and view all the answers

Which of the following vascular assessment techniques is described as an 'emerging technology' in the text?

<p>Spy technology intra operative evaluation with dye and imaging (D)</p> Signup and view all the answers

What is the recommended timing for performing a definitive amputation procedure after a vascular intervention?

<p>As quickly as possible after the vascular intervention (D)</p> Signup and view all the answers

What is the primary purpose of the 'angiosome concept' discussed in the text?

<p>To predict the healing potential of an amputation site based on vascular supply (D)</p> Signup and view all the answers

What is the key message conveyed by the quote 'I have cut many things that have bled poorly and healed well, and I have cut many thing that have bled well and healed poorly'?

<p>There are many unpredictable factors that influence wound healing beyond just vascular status (B)</p> Signup and view all the answers

How many angiosomes does the posterior tibial artery feed?

<p>3 (C)</p> Signup and view all the answers

Which artery supplies the lateral forefoot and entire plantar forefoot?

<p>Posterior tibial artery (C)</p> Signup and view all the answers

What is a major factor to consider for determining the amputation level for non-ambulatory patients?

<p>Family/social support (D)</p> Signup and view all the answers

Which artery supplies the medial plantar instep?

<p>Posterior tibial artery (C)</p> Signup and view all the answers

What anatomical structure does the anterior tibial artery become on the dorsum of the foot?

<p>Dorsalis pedis (B)</p> Signup and view all the answers

Based on the text, what is a significant consideration for successful limb salvage?

<p>Rehabilitation potential (C)</p> Signup and view all the answers

Which ASA Physical Status class corresponds to patients with a stable, chronic medical problem that is well controlled, such as stable diabetes?

<p>Class 2 (A)</p> Signup and view all the answers

Which amputation level is described as being frequently performed through the base of the proximal phalanx?

<p>Toes - Partial (C)</p> Signup and view all the answers

Which of the following is NOT a key factor in determining the need for a transmetatarsal amputation?

<p>Presence of a kidney transplant (D)</p> Signup and view all the answers

Which amputation level is described as involving the resection of the calcaneus?

<p>Calcanectomy (C)</p> Signup and view all the answers

Which artery supplies the medial plantar instep?

<p>The medial plantar artery (A)</p> Signup and view all the answers

What is the primary purpose of determining the level of adequate blood flow when considering the amputation level?

<p>To ensure primary skin healing at the amputation site (D)</p> Signup and view all the answers

Which surgical intervention is recommended for stabilizing hindfoot fusions for long-term success?

<p>Steinman pin or K-wires (C)</p> Signup and view all the answers

What surgical procedure is mentioned as necessary for stability and function 3 years after a specific case study?

<p>Fusing the ankle and subtalar joint (A)</p> Signup and view all the answers

Which condition warrants the insertion of antibiotic-contaminated tissue according to the text?

<p>Osteomyelitis (acute or chronic) (B)</p> Signup and view all the answers

What is the primary purpose of leaving intrinsic muscle stability around the metatarsal phalangeal joint?

<p>To provide dynamic stability during gait (B)</p> Signup and view all the answers

In the context of limb salvage, what surgical consideration is emphasized in the article by Boyd, H.R. from October 1939?

<p>Calcaneotibial arthrodesis (B)</p> Signup and view all the answers

What is the main indication for performing a lisFranc’s disarticulation?

<p>Failed transmetatarsal amputation (C)</p> Signup and view all the answers

Why is preservation of tendon emphasized in the context of amputations?

<p>To avoid equinus deformity (B)</p> Signup and view all the answers

What adjunct procedure is mentioned in the text related to transmetatarsal amputation?

<p>TAL or gastric recession (A)</p> Signup and view all the answers

What should be checked in patients before undergoing surgical procedures according to the text?

<p>Hemaglobin and Hematocrit (D)</p> Signup and view all the answers

Why is it recommended to have at least 2 units of blood available during surgery?

<p>To accommodate blood loss expectations (B)</p> Signup and view all the answers

What is a key consideration for utilizing a tourniquet in reconstructive surgery for patients with prior lower extremity revascularization?

<p>Ensuring safety in the presence of previous revascularization (B)</p> Signup and view all the answers

What is one of the emerging technologies mentioned for vascular assessment in the text?

<p>Transcutaneous Oxygen Pressure (A)</p> Signup and view all the answers

When discussing the timing of surgery after vascular intervention, what is the recommended duration post angioplasty?

<p>10 to 30 days (A)</p> Signup and view all the answers

What is a key concept used to predict the healing potential based on composite vascular territories?

<p>Angiosomes (A)</p> Signup and view all the answers

In limb salvage procedures, what is crucial for long-term success, as per the text?

<p>Stability of Hindfoot Fusions (A)</p> Signup and view all the answers

Which quote from the text touches on the variability in bleeding and wound healing outcomes?

<p>'I have cut many things that have bled poorly and healed well, and I have cut many things that have bled well and healed poorly.' (D)</p> Signup and view all the answers

What is a technological method recommended in the text for intraoperative evaluation during surgery?

<p>Spy Technology with Dye and Imaging (A)</p> Signup and view all the answers

Which ASA Physical Status classification corresponds to a patient with a stable, chronic medical problem that is well controlled, such as stable diabetes?

<p>ASA II (D)</p> Signup and view all the answers

A patient with a severe systemic disease that is a constant threat to life, such as severe congestive heart failure, would be classified as which ASA Physical Status?

<p>ASA IV (A)</p> Signup and view all the answers

Which ASA Physical Status classification is reserved for a patient who is not expected to survive without the operation?

<p>ASA V (B)</p> Signup and view all the answers

A patient with a severe, life-threatening systemic disease, such as multiple organ dysfunction syndrome, would be classified as which ASA Physical Status?

<p>ASA IV (D)</p> Signup and view all the answers

Which ASA Physical Status classification is used for a normal, healthy patient?

<p>ASA I (B)</p> Signup and view all the answers

A patient with a severe, incapacitating systemic disease that is a constant threat to life, such as advanced cardiac disease, would be classified as which ASA Physical Status?

<p>ASA IV (B)</p> Signup and view all the answers

In the ASA Physical Status classification, which class corresponds to patients with severe systemic disease that is a constant threat to life?

<p>ASA IV (C)</p> Signup and view all the answers

Which ASA Physical Status class includes patients with a moderate systemic disease or health issue?

<p>ASA II (D)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class includes a normal, healthy patient?

<p>ASA I (A)</p> Signup and view all the answers

Patients in ASA Physical Status class III are described as having what type of systemic disease?

<p>Moderate systemic disease (D)</p> Signup and view all the answers

Which ASA Physical Status classification is assigned to patients with a severe systemic disease that is not a constant threat to life?

<p>ASA III (D)</p> Signup and view all the answers

'ASA' in the ASA Physical Status classification stands for:

<p>American Society of Anesthesiologists (D)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class describes patients who are very seriously ill and require intensive perioperative care?

<p>Class 4 (A)</p> Signup and view all the answers

Which ASA Physical Status class is assigned to patients who are not expected to survive surgery or the perioperative period?

<p>Class 5 (C)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class would a patient with well-controlled type 2 diabetes mellitus be assigned to?

<p>Class 2 (B)</p> Signup and view all the answers

Which ASA Physical Status class is assigned to patients who have no medical problems other than the pathologic condition associated with the surgery?

<p>Class 1 (D)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class describes patients who are more seriously ill with unstable medical problems and likely need close medical supervision in the perioperative period?

<p>Class 3 (D)</p> Signup and view all the answers

Based on the ASA Physical Status classification, which class would a patient with a recent myocardial infarction be assigned to?

<p>Class 4 (B)</p> Signup and view all the answers

What is one major factor to consider for determining the amputation level for non-ambulatory patients?

<p>Rehabilitation potential (A)</p> Signup and view all the answers

Which artery supplies the lateral forefoot and the entire plantar forefoot?

<p>Calcaneal branch from the posterior tibial artery (D)</p> Signup and view all the answers

What is a key consideration for perioperative medical care according to the text?

<p>Evaluation of physical status by an anesthesiologist (C)</p> Signup and view all the answers

Why might it be advantageous to maintain a limb even if the patient is not ambulatory?

<p>Facilitation of prosthetic fitting (D)</p> Signup and view all the answers

Which artery feeds two angiosomes according to the text?

<p>Peroneal artery (B)</p> Signup and view all the answers

In limb salvage procedures, what is crucial for long-term success, as highlighted in the text?

<p>'Intrinsic muscle stability' preservation (C)</p> Signup and view all the answers

Which ASA Physical Status classification is assigned to patients who are not expected to survive surgery or the perioperative period?

<p>Class 5 (B)</p> Signup and view all the answers

A patient with a severe, life-threatening systemic disease, such as multiple organ dysfunction syndrome, would be classified as which ASA Physical Status?

<p>Class 4 (B)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class would a patient with well-controlled type 2 diabetes mellitus be assigned to?

<p>Class 2 (D)</p> Signup and view all the answers

Which ASA Physical Status classification is used for a normal, healthy patient?

<p>Class 1 (B)</p> Signup and view all the answers

According to the ASA Physical Status classification, which class describes patients who are more seriously ill with unstable medical problems and likely need close medical supervision in the perioperative period?

<p>Class 3 (D)</p> Signup and view all the answers

A patient with a severe, incapacitating systemic disease that is a constant threat to life, such as advanced cardiac disease, would be classified as which ASA Physical Status?

<p>Class 4 (D)</p> Signup and view all the answers

Which of the following medical conditions would warrant classification as ASA Physical Status IV according to the information provided?

<p>A patient with severe congestive heart failure (C)</p> Signup and view all the answers

Which of the following statements best represents the relationship between bleeding during surgery and wound healing outcomes?

<p>The relationship between intraoperative bleeding and wound healing is variable and unpredictable. (A)</p> Signup and view all the answers

Which of the following techniques is described as an 'emerging technology' for vascular assessment in the context of determining amputation levels?

<p>Spy technology – intra operative evaluation with dye and imaging (B)</p> Signup and view all the answers

Based on the information provided, which of the following statements accurately describes the timing of definitive amputation procedures after vascular interventions?

<p>The definitive amputation procedure should be performed as soon as possible after both bypass and angioplasty procedures. (A)</p> Signup and view all the answers

Which of the following statements accurately describes the concept of angiosomes as mentioned in the text?

<p>Angiosomes are composite vascular territories providing blood supply to specific structures like skin, nerves, muscle, tendon, and bone. (B)</p> Signup and view all the answers

According to the ASA Physical Status classification mentioned in the text, which class would be assigned to a patient with a severe systemic disease that is not a constant threat to life?

<p>ASA Physical Status III (C)</p> Signup and view all the answers

Flashcards

Gangrene

A condition where the tissues are not getting enough oxygen and nutrients, leading to death of the affected area. This often occurs in cases of diabetes or poor circulation.

Amputation

The procedure of removing a limb or a part of a limb, typically due to severe injury, infection, or lack of blood supply.

Limb Salvage

The process of attempting to save a limb instead of amputating it, often performed in cases of serious injuries or infections.

Ambulatory Status

The ability to move around and walk, which influences the choice of amputation level.

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Debridement

A significant surgical technique that removes infected, necrotic, or painful tissue. It aims to reduce infection and improve healing.

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Blood Supply

The level of blood supply to a specific area, which is essential for wound healing and determining the success of amputation.

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Blood Loss

The amount of blood loss during surgery, which can be significant in amputations. This influences the need for blood transfusions and pre-operation planning.

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Blood Units

The amount of blood available for transfusion during surgery, which is important in case of significant blood loss.

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Angiosome

An anatomical concept that divides the body into zones based on blood supply. This helps understand the potential for healing after amputation.

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Angiosome Zone

A specific area of the body that receives blood supply from a single artery. This helps predict the success of healing after an amputation.

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Dorsalis Pedis Artery

The artery that primarily supplies blood to the dorsum of the foot, a crucial area for wound healing after lower extremity amputations.

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Medial Plantar Artery

An artery that supplies blood to the medial plantar aspect of the foot, important for healing after forefoot amputations.

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Posterior Tibial Artery

An artery that supplies blood to the lateral forefoot and plantar forefoot, vital for healing after amputations.

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Ray Resection

The procedure of removing one or more rays (toe and its associated metatarsal) from the foot.

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Transmetatarsal Amputation

A special type of amputation that aims to preserve as much foot length as possible, often used in cases of gangrene of the tissues.

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Charcot Deformity

An abnormal thickening and hardening of bone tissue, which can be associated with diabetic neuropathy and lead to significant foot deformities.

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Verruca

A type of benign skin growth that can sometimes occur on the toes, leading to complications like infection and requiring surgical removal.

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Osteomyelitis

An inflammation of the bone, often caused by infection. It can complicate foot problems like diabetes and require surgical intervention.

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Diabetic Neuropathy

A condition characterized by damage to nerves, often associated with diabetes. It can lead to loss of sensation and increase the risk of foot injuries.

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Calcanectomy

A procedure that involves removing a portion of the calcaneus (heel bone), often performed in cases of severe heel deformities or infection.

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Arthrodesis

The process of fusing two or more bones together, primarily used to stabilize joints and improve function after injuries or deformities.

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Calcaneotibial Arthrodesis

A specific type of arthrodesis where the calcaneus (heel bone) and tibia (shin bone) are joined together, aimed at stabilizing the ankle joint and restoring function.

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Equinus Deformity

A condition characterized by a pointed toe position due to muscle imbalance, often caused by weakness or impairment of the calf muscles.

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Soft Tissue Envelope

A condition where the soft tissues are unable to cover the bone, leading to complications like infection and delay in healing.

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LisFranc's Disarticulation

A surgical procedure involving removing the toes and metatarsals of the foot, often required for severe problems like gangrene and infection.

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Gastrocnemius Recession

A surgical procedure involving removing a section of the gastrocnemius muscle (calf muscle), often used to improve foot function by correcting equinus deformity and improving dorsiflexion.

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Spy Technology

A minimally invasive surgical technique that evaluates blood flow by injecting dye and capturing images to assess the vascular status before amputation.

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Ankle and Subtalar Joint Fusion

A complex surgical procedure involving fusing the ankle and subtalar joints, often used to stabilize the foot and improve function after severe deformities.

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ASA Physical Status

A medical classification system that categorizes patients based on their overall health status, ranging from Class 1 (healthy) to Class 5 (moribund).

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