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Questions and Answers
Which of the following is an upper limb amputation occurring at the level of the elbow?
Which of the following is an upper limb amputation occurring at the level of the elbow?
A Syme's Amputation is classified as a type of lower limb amputation.
A Syme's Amputation is classified as a type of lower limb amputation.
True
What is the primary purpose of assessing a limb's viability before amputation?
What is the primary purpose of assessing a limb's viability before amputation?
To determine if the limb can be saved or if amputation is necessary.
An amputation performed at the level of the ankle joint is known as __________.
An amputation performed at the level of the ankle joint is known as __________.
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What type of amputation occurs across a joint?
What type of amputation occurs across a joint?
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Match the type of amputation with its description:
Match the type of amputation with its description:
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Which imaging technique provides detailed images of soft tissues in assessing the need for amputation?
Which imaging technique provides detailed images of soft tissues in assessing the need for amputation?
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A transverse amputation refers to an amputation that crosses through a joint.
A transverse amputation refers to an amputation that crosses through a joint.
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Upper limb amputations include procedures like wrist and ankle disarticulations.
Upper limb amputations include procedures like wrist and ankle disarticulations.
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Match the type of amputation with its description:
Match the type of amputation with its description:
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Prosthetics are often required for mobility after an amputation of the ________ extremity.
Prosthetics are often required for mobility after an amputation of the ________ extremity.
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What is the purpose of involving an interdisciplinary team in the decision-making process for amputation?
What is the purpose of involving an interdisciplinary team in the decision-making process for amputation?
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Name one type of injury that could lead to a traumatic amputation.
Name one type of injury that could lead to a traumatic amputation.
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Which of the following statements best describes the impact of upper extremity amputation?
Which of the following statements best describes the impact of upper extremity amputation?
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Prosthetic devices used for upper limb amputations generally restore function to the same degree as those used for lower limb amputations.
Prosthetic devices used for upper limb amputations generally restore function to the same degree as those used for lower limb amputations.
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Amputations affecting the lower extremity require assistance for ________ and ________.
Amputations affecting the lower extremity require assistance for ________ and ________.
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What is an important consideration in determining the level of amputation?
What is an important consideration in determining the level of amputation?
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The aesthetic appearance of the stump does not affect the patient's decision regarding the level of amputation.
The aesthetic appearance of the stump does not affect the patient's decision regarding the level of amputation.
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What is the primary benefit of preserving the thumb in upper limb amputations?
What is the primary benefit of preserving the thumb in upper limb amputations?
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Longer residual limbs provide an extended lever arm for powering a ________.
Longer residual limbs provide an extended lever arm for powering a ________.
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What is one of the main advantages of performing pediatric amputations at the joint level?
What is one of the main advantages of performing pediatric amputations at the joint level?
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Match the following types of amputations with their descriptions:
Match the following types of amputations with their descriptions:
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What does proprioception refer to in the context of amputations?
What does proprioception refer to in the context of amputations?
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A residual limb that is too long may hinder the fitting and use of a prosthesis.
A residual limb that is too long may hinder the fitting and use of a prosthesis.
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Study Notes
Principles of Amputation
- Limb amputation is a very old surgical procedure, dating back to the Babylonian code of Hammurabi (1700 BC) and Hippocrates (385 BC).
- Amputation is the cutting off of a limb or part of a limb due to trauma, constriction, surgery, or to control disease (e.g., malignancy, infection, gangrene).
- Amputations can be preventative or done due to congenital disorders.
- Amputation should only be considered when the limb is non-viable (gangrenous, grossly ischemic, dangerous malignancy, or infected) or non-functional.
- A well-planned amputation can remove a painful, dysfunctional limb and allow rehabilitation with a prosthetic limb to a functional, painless state.
Causes of Amputation
- In developed countries, peripheral vascular disease is the leading cause.
- Trauma, infection, uncontrolled diabetes mellitus, and malignancies are leading causes in developing countries, according to global surveys.
- Amputation patients in developing countries are often younger.
Levels of Amputation
- Amputation can be a disarticulation of a joint or a transection through a long bone
- When amputation occurs across a bone shaft, it's considered transverse (e.g., trans-radial or trans-tibial).
- When amputation occurs across a joint, it's considered a disarticulation (e.g., elbow or hip disarticulation).
Types of Limb Amputations
- Types of upper limb amputations include those involving different parts and segments of the arm.
- Lower limb amputations include forequarter, and different types for each leg, and foot amputations.
Causes of Amputations (Cont'd)
- Congenital limb deficiency (e.g., phocomelia)
- Vascular issues (ischemia, diabetes, frostbite, arterial insufficiency, gangrene, chronic leg ulcers).
- Infections (e.g., bone infection).
- Malignant tumors (e.g., sarcoma).
- Trauma (e.g., limb injury from accidents, stabbing, gunshot, animal bites).
Assessment of Amputation
- The decision to amputate involves interdisciplinary discussion (with the patient whenever possible).
- Pre-amputation investigations are necessary:
- X-rays to check for fractures or disease
- Computerized tomography (CT) scans for detailed images of bones, tissues, and blood vessels
- Angiograms to outline blood vessels
- Doppler ultrasound to check for occlusions (blockages) in blood vessels
- Venograms and arteriograms for detailed imaging of blood vessels.
Post-amputation Considerations
- Blood supply to the limb needs assessment before amputation.
- Limb viability must be established before the procedure
- The boundary of diseased tissue must be clearly defined to avoid further illness
- The level of amputation requires careful consideration to ensure suitability for prosthetics and maximum mobility and function.
- The shape and length of the residual stump impact cosmesis (appearance).
Clinical management
- Preservation of the thumb or fine motor skills in upper limb amputations is important.
- Longer residual limbs allow for better prosthetic fitting and control, more surface for gripping, and better proprioception
- Pediatric amputations preserve epiphyses (growth plates of bones)
- Techniques like Myoplastic closure help ensure stability, shape and padding
- Prosthesis fit should be adequate and adjusted to prevent weight & pressure issues
- Healing and blood supply of the residual limb must be evaluated and managed carefully after surgery
Post-Surgical Management
- Rehabilitation after surgery is essential to prepare the patient for prosthetics
- Rehabilitation phases help reshape the residual limb to aid in fitting.
- Devices and bandages used include RRDs, ace bandages, or shrinkers (pressure socks)
- Immediate postoperative fittings may be possible with prefabricated devices, adjustable postsurgical systems
Post-amputation follow up
- Pain management, swelling control, and wound care are important.
- Patient education about the residual limb and its use is vital for proper prosthetic fitting and use post-surgery.
- Addressing potential phantom limb sensations, and maintaining strength, range of motion, and mobility in the remaining body are included in the rehabilitation plan.
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Description
This quiz covers the historical context and principles of limb amputation, exploring its indications and causes in both developed and developing countries. Test your knowledge on the significance of this surgical procedure and its implications for patient health and rehabilitation.
