0000005188 00000 n 0000079578 00000 n Copyright 2022 Lineage Medical, Inc. All rights reserved. You may also temporarily experience phantom pains or sensitivity. Her ankle-brachial index (ABI) for her right posterior tibial artery is 0.4. 0 startxref Close to 2 million Americans are living with some type of amputation. amputations are done urgently and electively to reduce pain, provide independence, and restore function, prevention of adjacent joint contractures, early return of patient to work and recreation, 1.7 million individuals in the United States with an amputation, 80% of amputations are performed for vascular insufficiency, Amputations may be indicated in the following, most common reason for an upper extremity amputation, most common reason for a lower extremity amputation, perform amputations at lowest possible level to preserve function, Syme amputation is more efficient than midfoot amputation, inversely proportional to length of remaining limb, Ranking of metabolic demand (% represents amount of increase compared to baseline), varies based on patient habitus but is somewhere between transtibial and transfemoral, most proximal amputation level available in children to maintain walking speeds without increased energy expenditure compared to normal children, measurement of doppler pressure at level being tested compared to brachial systolic pressure, pressure-sensitive implanted medical device (automatic implantable cardiac defibrillator, pacemaker, dorsal column stimulator, insulin pump), Amputation versus limb salvage and replantation, mangled upper extremity has a far greater impact on overall function than does a lower extremity amputation, upper extremity prostheses have much more difficulty replicating native dexterity and sensory feedback provided by the native limb, results of nerve repair and reconstruction are more successful in upper extremity than lower extremity, superior functional outcomes can be expected in replanted limbs compared with upper extremity amputations, diminishing outcomes from replantation are expected the more proximal the level, especially about the elbow, wrist disarticulation or transcarpal versus transradial amputation, recommended in children for preservation of distal radial and ulnar physes, can be difficult to use with highly functional prosthesis compared to transradial, Although, this may be changing with advancing technology, easier to fit prosthesis (myoelectric prostheses), transhumeral versus elbow disarticulation, indicated in children to prevent bony overgrowth seen in transhumeral amputations, All named motor and sensory branches within operative field should be identified and preserved, can result in improved muscle mass and preserve the ability to create myoelectric signal for targeted reinnervation, myodesis, the process of attaching the muscle-tendon unit directly to bone is recommended, anchor wrist flexor/extensor tendons to carpus, middle third of forearm amputation maintains length and is ideal, residual 5cm of ulna is required for elbow motion, but at this level will have limited pronation/supination, ideal level is 4-5cm proximal to elbow joint, At least 5-7cm of residual length is needed for glenohumeral mechanics, retain humeral head to maintain shoulder contour, designed to improve control of myeolectric prostheses used for amputation, transfer amputated large peripheral nerves to reinnervated functionally expendable remaining muscles to create a new discrete muscle signal for the myoelectric prosthesis control, secondary benefit of alleviating symptomatic neuroma pain, however, ideal cut is 12 cm (10-15cm) above knee joint to allow for prosthetic fitting, 5-10 degrees of adduction is ideal for improved prosthesis function, creates dynamic muscle balance (otherwise have unopposed abductors), provides soft tissue envelope that enhances prosthetic fitting, amputation through the femur near level of adductor tubercle, synovium is excised to prevent postoperative effusion, patella is arthrodesed to the end of femur for improved end bearing, prepatellar soft tissue is maintained without iatrogenic injury, improved outcomes as compared to transfemoral amputation, ambulatory patients who cannot have a transtibial amputation, suture patellar tendon to cruciate ligaments in notch, use gastrocnemius muscles for padding at end of amputation, Consequence of poor soft tissue envelope from loss of gastrocnemius padding, 12-15 cm below knee joint is ideal (10-16cm of residual tibia bone), longer than this gets into the achilles tendon which has a suboptimal blood supply and ability for soft tissue cushioning, need approximately 8-12 cm from ground to fit most modern high-impact prostheses, preventable with well-designed incision lines, preserve blood supply to the posterior flap, designed to enhance prosthetic end-bearing, argument is that the bone bridge will enhance weight bearing through the fibula and increase total surface area for load transfer, increased reoperation rates have been reported, the original Ertl amputation required a corticoperiosteal flap bridge, the modified Ertl uses a fibular strut graft, requires longer operative and tourniquet times than standard BKA transtibial amputation, fibula is fixed in place with cortical screws, fiberwire suture with end buttons, or heavy nonabsorbable sutures, used successfully to treat forefoot gangrene in diabetics, medial and lateral malleoli are removed flush with distal tibia articular surface, the medial and lateral flares of the tibia and fibula are beveled to enhance heel pad adherence, removal of the forefoot and talus followed by calcaneotibial arthrodesis, calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal, allows patient to mobilize independently without use of prosthetic, Chopart or Boyd amputation (hindfoot amputation), a partial foot amputation through the talonavicular and calcaneocuboid joints, avoid by lengthening of the Achilles tendon and, leads to apropulsive gait pattern because the amputation is unable to support modern dynamic elastic response prosthetic feet, unopposed pull of tibialis posterior and gastroc/soleus, prevent by maintaining insertion of peroneus brevis and performing achilles lengthening, a walking cast is generally used for 4 week to prevent late equinus contracture, Energy cost of walking similar to that of BKA, more appealing to patients who refuse transtibial amputations, almost all require achilles lengthening to prevent equinus, preserves insertion of plantar fascia, sesamoids, and flexor hallucis brevis, reduces amount of weight transfer to remaining toes, prevent with early aggressive mobilization and position changes, trauma-related amputation have an infection rate of around 34%, prevent with proper nerve handling at the time of procedure, a method of guiding neuronal regeneration to prevent or treat post-amputation neuroma pain and improve patient use of myoelectric prostheses, occurs in 53-100% of traumatic amputations, mirror therapy is a noninvasive treatment modality, most common complication with pediatric amputations, prevent by performing disarticulation or using epihphyseal cap to cover medullary canal, Outcomes are improved with the involvement of psychological counseling for coping mechanisms, Involves a close working relationship between rehab physicians, prosthetists, physical therapists, as well as psychiatrists and social workers, High rate of late amputation in patients with high-energy foot trauma, highest impact on decision-making process, 2nd highest impact on surgeon's decision making process, plantar sensation can recover by long-term follow-up, SIP (sickness impact profile) and return to work, mangled foot and ankle injuries requiring free tissue transfer have a worse SIP than BKA, most important factor to determine patient-reported outcome is the ability to return to work, About 50% of patients are able to return to work, study focused on military population in response to LEAP study, slightly better results in regard to patient-reported outcomes for the amputation group with a lower risk of PTSD, more severe limbs were going into salvage pathway, military population with better access to prostheses, higher rates of return to vigorous activity in the amputation group, Descending thoracic aorta graft, with or without bypass, Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency. 0000008059 00000 n What complication of pediatric amputations is avoided with a knee disarticulation as opposed to a transtibial amputation? 966 0 obj <> endobj What is this patient's most likely lower extremity amputation level? Which type of deformity is the most likely complication of this procedure? 0000003064 00000 n 0000005990 00000 n (OBQ10.145) 0000006418 00000 n She elects to undergo an amputation. hbbd``b` $/@]HIXX} b " VnisR@B He &FP q|WlK_ 0 1053 0 obj <>stream tenodesing the extensor digitorum longus to the tibial shaft. The site will initially be very swollen and painful and will need to be cleaned frequently to prevent a bacterial infection. A cosmetic prosthesis is for appearance only and does not move. Once your arm is sufficiently healed, you can be fitted forprosthetics in Memphis, TN. Which of the following statements best describes the forces resulting in this deformity? 0000042184 00000 n A radiograph of the chest shows a small pneumothorax which is being observed and does not require a thoracostomy tube. Figure A shows a below the knee amputation performed in a diabetic patient with significant vascular disease. (OBQ04.227) Which of the following has the most impact on the decision to attempt limb salvage versus amputation? hb```b``>Abl,$6LQLdIZ7G-9l$pFyV 4F o^\\m-/. (OBQ09.201) At other times, a doctor might decide amputation is necessary because of other damage to your hand or lower arm. %%EOF The number one reason for transradial amputation is trauma to the hand and arm. A 7-year-old male is struck by a motor vehicle while crossing the street and suffers an open tibia fracture with a crush injury of the ipsilateral foot. hb```LF 9 b) %kl$7I^znv6c`EyuQY!X. 0000020516 00000 n (OBQ12.171) The patient's neurovascular status necessitates the amputation demonstrated in figures A through C. One year following the amputation, the patient complains of difficulty with gait and deformity of the ankle. 0000003506 00000 n A 34-year-old male is an inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle collision. 0000008725 00000 n Operative debridement and irrigation within 1 hour of injury. In fact, many patients are able to regain the use of their damaged limbs and lead relatively normal lives. It persists despite a well-fitted prosthesis. %%EOF Less postoperative time to final prosthesis fitting. 0000010133 00000 n 0000079743 00000 n Improved performance on the Sickness Impact Profile (SIP) questionnaire, Physicians were more satisfied with the cosmetic appearance, Decreased dependence with patient transfers. 0000096314 00000 n 0000123843 00000 n He undergoes transfemoral amputation. (OBQ05.150) Which of the following is most important to achieve a good outcome following a Syme amputation? 0000021229 00000 n When discussing the amputation levels with the patient, which of the following should be noted to require the greatest increase in energy expenditure for ambulation? Six months after the amputation he has persistent difficulty with ambulation because his distal femur moves into a subcutaneous position in his lateral thigh. During a Lisfranc (tarsometatarsal) amputation of the foot, which of the following is crucial to prevent the patient from having a supinated foot during gait.

Sitemap 24