Lower Extremity Amputations: Causes and Conditions

Lower Extremity Amputations

• Primary Causes: Vascular disease (most common, linked to diabetes, atherosclerosis, smoking), trauma, burns, frostbite, cancer, and congenital conditions.
• Vascular Disease (most common): Atherosclerosis, and diabetes. These diseases narrow or block arteries, reducing blood flow. Smoking further exacerbates this.
• Buerger's Disease: A rare form of blood vessel inflammation (thromboangiitis obliterans), usually affecting hands and feet in the third to fifth decades. Smoking cessation can halt its progression.
• Diabetes Mellitus: Often leads to foot problems due to diabetic peripheral neuropathy and atherosclerotic peripheral artery disease. These factors impair sensation, structure, and blood flow to the feet, increasing risk of ulceration.
• Foot Ulceration: A common complication of diabetes, affecting 15-25% of people with diabetes.
• Diabetic Foot Ulcers: Result from impaired sensation, structural abnormalities, and poor blood flow to the injured area.
• Cellulitis: Infection of the skin tissue.
• Osteomyelitis: Infection of the bone.

Levels of Amputations - Lower Extremity (LE)

• Hemipelvectomy: Removal of the lower half of the pelvis and the entire lower limb.
• Hip Disarticulation: Removal of the hip joint.
• Transfemoral (Above Knee): Amputation above the knee joint.
• Van Ness (Rotationplasty): A specific reconstructive procedure.
• Knee Disarticulation: Removal of the knee joint.
• Transtibial (Below Knee): Amputation below the knee joint.
• Syme's (Ankle Disarticulation): Removal of the ankle joint.
• Partial Foot/Fore Foot Amputation: Removal of a portion of the foot.
• Ray Resection (Toe): Removal of toes.

Diabetic Amputation Stats

• Diabetes is a major contributing factor to non-traumatic lower-limb amputations.
• Roughly 70% of non-traumatic lower limb amputations.
• One-third of lower-limb amputations in 2011-12 were performed on people reporting a diabetic foot wound.

Post-Surgery Considerations

• Edema Management: Post-surgical swelling can be managed with specific dressing techniques.
• Residual Limb Wrapping: Techniques like tensor bandaging and figure-of-8 wrapping are used for compression to minimize swelling and protect the stump.
• Prosthetic Devices: Choice of device depends on the level of amputation, patient factors, and lifestyle.

Upper Extremity (UE) Amputations

• Partial Hand and Digital Amputations: Trauma, congenital conditions, and workplace injuries are frequent causes.
• Causes of UE amputations: Trauma, congenital conditions.

Prosthetic Devices

• Types: Various prosthetic devices, including hooks, prehensors (grippers), and hands. Their design varies based on the user's needs and the level of amputation for both UE and LE.
• Function: Prosthetic devices improve function and restore some daily activity, but not all tasks are easily performed or accomplished.
• Considerations: User training and adjustment to prosthetic devices are necessary.

Additional Factors

• Age: The average age of amputees varies depending on the cause of amputation.
• Sex: The proportion of males and females who undergo amputation varies.
• Medical Conditions: Amputation is often associated with medical conditions such as diabetes, vascular disease, and cancer.
• Impact on Quality of Life: Amputation can impact daily activities and overall quality of life; considerations and support systems are crucial.

Overview of primary causes for lower extremity amputations including vascular diseases, trauma, and congenital conditions. Focus on diseases like atherosclerosis, diabetes, and Buerger's disease. Discusses diabetic foot ulcers, a common complication.