Amputation PDF

Amputation  is the removal/cutting of a body extremity or other part. Congenital or Acquired (traumatic, AMPUTATION ischemic, or surgical) It is used to relieve symptoms, improve function, and save or improve the patie...

Amputation  is the removal/cutting of a body extremity or other part. Congenital or Acquired (traumatic, AMPUTATION ischemic, or surgical) It is used to relieve symptoms, improve function, and save or improve the patient’s quality of life  Individuals with:  Peripheral arterial disease (PAD)  Diabetes mellitus Individuals at  Inactive individuals risk:  Hypertension  Hyperlipidemia  Somkers  Diabetic foot infection or gangrene - prevent Cancerous bone or soft tissue tumours - to spreading / pauiatiu Severe limb injuries in which the limb cannot be spared or Factors that attempts to spare the limb have failed - lead to Circulation problems - amputation: Congenital deformities of digits and/or limbs - Extra digits and/or limbs extra - finger Any advanced cancers -  prevent / to Bone infection (osteomyelitits) eaten up by spread - the the infection Traumatic amputation - Factors that lead to Amputation in utero (amniotic band) - cooling and of umbilical amputation: Punishment/Torture - Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance.   Chronic elevation of blood glucose level leads to damage of blood vessels. blood vessels.  The endothelial cells lining the blood vessels don`t depend on insulin and take in more Diabetes and  glucose than normal. It causes the basement membrane to grow Vascular thicker and weaker. They then form more surface glycoproteins Disease  than normal  In diabetes, the resulting problems are grouped under "microvascular disease" (due Sclerosis - hardening to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries).  ischemic pain PAD is a progressive It most often atherosclerotic involves the disease arteries of the characterized by lower extremities occlusion and stenosis. Peripheral Arterial Risk factors include advancing age, Results in decreased blood Disease flow to the legs hypertension, and feet resulting dyslipidemia in pain, functional (elevation of impairments, tissue cholesterol), and loss, gangrene and sedentary lifestyle. amputation. Return Patient to maximum level of independent function Ablation of diseased tissue (tumor or infection) Reduce morbidity & mortality (tumor or AIM infection) Considered first part of a Reconstruction to produce a physiological end organ physiological end organ not fruition  Two factors are considered: Levels of  Circulation Amputation:  Functional usefulness Levels of Amputation  Good bandaging to mold the stump into Conical shape to accept the prosthesis. Avoid proximal compression of the limb. Aftercare Prevent contracture (by splinting and / or muscle exercises) Early prosthetic fitting  Usually for congenital limb deficiencies Try to retain limb if possible Children Preserve length Disarticulate, if possible, to preserve growth potential rather than trans-diaphyseal amputation (bony overgrowth) Haematoma Infection Necrosis of stump end Contractures (due to muscle imbalance) Complications Neuroma at the cut nerve ending Phantom pain Terminal overgrowth (children) Pain  In the postoperative period must distinguish between normal postoperative (ie, surgical) pain and phantom limb pain.  Surgical pain usually responds well to opioids.  Phantom limb pain usually is like a burning, stinging, electric pain, and it can be increased with anxiety and stress.  Phantom pain is quite common initially,  If it is still present at 6 months postsurgery, the prognosis is unfavorable.  Phantom limb sensation also must be differentiated from phantom limb pain.  Phantom limb sensation is the sensation that the amputated limb is still present limb is still present.  Patients usually report that the absent hand/arm/limb is itching, tickling, or moving through space.  Phantom sensation is perceived as a "funny" or "different" feeling but usually is not perceived as painful. Phantom Limb Pain Theories:  Three theories as to why patients experience phantom limb pain and sensation exist.  One theory is that the remaining nerves continue to generate impulses.  A second theory is that the spinal cord nerves begin excessive spontaneous firing in the absence of expected sensory input from the limb.  The third theory is that there is altered signal transmission and modulation within the somatosensory cortex.  First line: antidepressants & anticonvulsants. Pain Mx: Some success using N-methyl- D-asparate antagonists, gabapentin, calcitonin, mexiletine, & opiates. Telescoping  Telescoping is the sensation that the distal part of the amputated extremity has moved proximally up the arm.  A patient might report that it feels like the entire extremity has shrunk so that the hand is now up at the elbow.  This is a normal part of the nerve healing process and usually fades with time.  Residual limb - The preferred term for the remaining portion of the amputated limb.  Terminal device - Most distal part of the prosthesis used to do work (eg, hand)  Myodesis - Direct suturing of muscle or tendon to bone  Myoplasty - Suturing muscles to periosteum  Prehensile - Grasp  Forequarter Amputation - Is the removal of the upper limb with the scapula; Mainly for malignancy  Shoulder  Disarticulation  Proximal amputation  Above Elbow Amputations - Use equal anterior and posterior flaps. Divide the muscles 5 cm below the bony resection. Suture triceps to anterior muscles  Elbow Disarticulation - Leave the articular surface intact and suture tendons of flexors to extensors. Close flaps over drains.  Elbow disarticulation versus Humeral Amputation  Better suspension with elbow disarticulation but poor cosmesis  Better function with distal humeral amputation (3.5 cm proximal to elbow)  Below Elbow Amputations - Try to Preserve Length. Myoplastic closure or suturing flexors to the extensor group  Krukenberg Procedure - Separate radial and ulna rays distally forming radial and ulna pincers capable of strong prehension and excellent manipulative ability  CRABS MR.  Wrist disarticulation - Preserves forearm rotation. The Flare of distal radius improves prosthetic suspension. Difficult prosthetic fitting due to length. Resect radial and ulna styloids' without damage to distal radio-ulna joint.  Transcarpal - Use a long palmar and short dorsal fish mouth flap (2:1). Suture tendons over the ends of the carpus  Hand Amputations - Preserve length, function, sensation. For irreversible Ischemia and tumours.  Finger Amputation - From Distal to PIPJ (terminal phalanx); To Proximal to base Mc (Whole ray).  Thumb Amputation - Preserve: Length as much as possible, Stability as good as possible, Sensation , Mobility, & Cosmesis. Prosthetics  What is the difference between a prosthesis and an orthosis?  A prosthesis is a device designed to replace, as much as possible, the function or appearance of a missing limb or body part.  An orthosis is a device designed to supplement or augment the function of an existing limb or body part. Pre-op Eval:  Tissue  Clinical - feel pulses, skin temperature, level of dependent redness  Doppler (U/S)– check limb circulation; inaccurate with calcified blood vessels  Arteriogram  control diabetes Systemic evaluate cardiac, renal + cerebral circulation Preoperative calorie’s control in malnourished patient. early plan for return to function Psychological preoperative counseling amputee support groups Preoperative Pain clinic review Pain Control Spinal anaesthesia Medical Mx: Goal: non-tender & healthy Promote healing: residual limb for prosthetic use. - careful handling - controlling edema -preventing infection  Types of dressings: ' - closed rigid dressing _ - removable rigid dressing - soft dressing  Need time to grieve their loss – permanent change in body image May feel angry, bitter, hostile, denial, Psychological withdrawal, depression, anxiety Support Multidisciplinary rehabilitation team ! run Goal: help client achieve optimal functioning  Relief of pain Absence of altered sensory perceptions Acceptance of altered body image Plan Independence of self-care Absence of complications Restoration of physical mobility Wound healing THANK YOU!