Lower Extremity Amputations: Causes and Levels

Lower Extremity Amputations

• Primary causes of lower extremity amputations include vascular disease (most common), trauma, burns, frostbite, cancer, and congenital defects.
• Vascular disease is often associated with diabetes, atherosclerosis, and smoking.
• Buerger's Disease (thromboangiitis obliterans) is an intermittent vascular inflammation typically starting in the third to fifth decade of life. Smoking cessation halts disease progression.
• Diabetes Mellitus often leads to foot problems, including diabetic peripheral neuropathy and atherosclerotic peripheral artery disease.
  • Foot ulceration affects 15-25% of people with diabetes during their lifetime.
  • Diabetic foot ulcers are characterized by impaired sensation, structural abnormalities, and poor blood flow to injured areas.
• Cellulitis is an infection at the skin, and osteomyelitis is an infection at the bone.

Levels of Amputations - LE

• Hemipelvectomy

• Hip Disarticulation

• Transfemoral (above knee)

• Van Ness (rotationplasty)

• Knee Disarticulation

• Transtibial (below knee)

• Syme's (ankle disarticulation)

• Partial Foot/Forefoot Amputation

• Ray Resection (toe)

• Rays Resection and Partial foot amputations severely limit high-performance activity and impact endurance and righting reactions. Pressure redistributes to other areas of remaining foot.

• Syme's ankle disarticulation requires no-weight bearing (NWB) initially and pivot transfer to the other leg to promote walking. Prosthetic use allows longer walking distances once healed.

Below Knee Amputation (post-surgery)

• Non-weight bearing (NWB) initial status (after surgery.)
• Walking aids may be required for ambulation (physical assist.)
• Adaptive devices and/or assisted devices (assistance with activities of daily living (ADLs) may be necessary.)
• Patients may need to suspend work for 3-6 months.
• Active leisure activities may be limited.

Managing Edema Post-Surgery

• Edema management strategies (post-surgery) include Ossur Rigid Dressing (ORD) and residual limb wrapping (including tensor bandage, figure-of-8 wrapping; pressure over bony prominences.)
• Elastic tubular bandage is another technique (including proximal constriction)

Measuring for Compression

• Measurement for compression bandages focuses on distal, below-knee, and above-knee areas.
• Different pressures (low, medium, high) in mmHg are used to manage compression and swelling.

Overview of lower extremity amputations, detailing primary causes such as vascular disease, trauma, and congenital defects. Focus on vascular diseases like diabetes and Buerger's, foot problems, and levels of amputation.