Busy. Please wait.
or

show password
Forgot Password?

Don't have an account?  Sign up 
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove Ads
Don't know
Know
remaining cards
Save
0:01
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards




share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Special Topics

Amputations

QuestionAnswer
Amputation Statistics -Early centuries: -Amputations primarily from gangrene and war -Most devices were designed as “peg legs” -Present day: -Major cause is Peripheral Vascular Disease (PVD)- 54%3 -PVD- diseases of blood vessels outside the heart and brain
Amputation statistics cont... -Present day: -Trauma-related amputations (45%) -MVC, gun shot wounds, & war -Usually young men -Tumors (<2%)
Amputation statistics cont... -2013> 2 million living with limb loss ~185,000 amputation/yr in US -50% w/ amputation vascular disease die in 5 yrs -55% of diabetics w/ LE amputation, require amputation of second leg in 2‐3 years -Smokers- increased infection and re-amputation
Amputation statistics cont... -African Americans -4x more likely to amputate than European Americans -Highest males ≥ 75 yrs -Lowered amputation rates Due to advanced diagnostics, revascularization, wound healing -Non-traumatic leg/ foot levels ↓ed 65% 1996-2008 in 40 y.o.
Measures to determine level of amputation through examining tissue viability -Doppler US study of blood vessels -Transcutaneous oxygen measurement (TCOM) of skin circulation by electrodes -Skin blood flow by radioisotope scan
What is amputation -Remove limb portion or segment -Allow for primary or secondary wound healing -Construct residual limb (RL) for optimal prosthetic fitting and function
Tissues affected by amputation -Blood vessels -Nerves -Bones -Muscles -Skin
Hemostasis is achieved by -Binding major veins and arteries
Cauterization is used for -Small vessels
Important that care is taken to... -Not compromise circulation to distal tissues including skin flaps
Nerves -Form neuromas (nerve fiber tumors) in residual limb -Neuromas must be well surrounded by soft tissue to avoid pain & interfere with the prosthesis -Nerves are pulled down under tension, cut, allowed to retract into soft tissue for protection
Muscles -Muscles stabilization to other tissues allows for max retention of function
Myofasical -muscle to fascia
Myoplasty -muscle to muscle
Myodesis -cut muscle to bone
Tenodesis -tendon to bone
Bones -Left at a length to allow wound closure without excessive bone at the distal end of the RL -Sharp bone ends are smoothed and rounded
Ertl procedure -Tibfib bone bridge -Facilitates natural bridging -Better load bearing -Better shaping -Less muscle retraction
Skin flaps are left... -broad -equal length flaps results in incision at distal end
Scar should be... -Pilable, P!less, non-adherent
Long posterior flaps -Improves circulation because the posterior tissues more vascular than anterior -Scar anteriorly over the end of the tibia -Care must be taken to ensure the scar does not become adherent to the bone
Skew flap -Diagonal scar for better blood circulation -Medial lower leg more vascular than lateral
Partial toe amputations -Removal of part of toe(s) -Won't affect function significantly
Toe disarticulation -Removal at MTP joint(s) -Most problems with great toe -May require foot orthotic for arch support because of lost medial support
Partial foot (more common) -Transmetatarsal: Removal at MT level, will need prosthesis to walk normally -Transtarsal: -Chopart (shō-ˈpärz)- removal within the tarsals -Lisfranc (lis-frahnk′)- removal between tarsals and MTs
Ankle amputations: Syme's -Removal just above the malleoli -Ankle disarticulation -No foot remains
Ankle amputation: Pirigoff -Aka Modified Syme's -Calcaneus saved
Transtibial Amputations (more common) -Aka Below Knee Amputations (BKA) -Sublevels (% of tibia remaining) -Long- > 50% -Standard- 20-50% -Short- < 20%
Knee disarticulation -Perf. through tibiofemoral jt -Will need prosthesis with a special knee jt.
Transfemoral Amputations (more common) -Aka Above Knee Amputations (AKA) -Sublevels: % of femur remaining -Long- >60% -Standard- 35-60% -Short- <35%
Hip and Pelvis Amputations -Most perf. either for tumors or severe trauma -Represent a small percentage of the amputee population -Disarticulation- through the joint
Hemipelvectomy -Lower 1/2 of pelvis removed
Hemicorporectomy -Everything below L4 removed; not common
Guillotine amputations -Emergency (quick) amputation -May precede secondary closure with skin flaps -Occasionally, free tissue flaps, taken from some other area of the body, may be used to cover deformities
Dirty trauma amputations -Amputation in the presence of unclean tissue -Secondary Intention healing -Left open so the wound can be cleaned before closure -Trying to decrease the chance of infection
Post-operative dressings -Swelling control/Increase venous return -RL formation -Prevent: -Flesh role (superomedially) -Flexion contractures -Comfort -Protection/hygiene -Desensitization -Proprioception with earlier walking
Immediate Postoperative Prosthesis (IPOP) -Not removable -Then there are Removable Rigid Dressings (RRD)
Semi-rigid-Unna boot -Compression dressing -100% cotton gauze -Impregnanted with a non-hardening zinc oxide paste
Cont...post-op dressings -Soft: elastic wraps (ACE) -Shrinkers -Use 2-3 4” or 6” ACE bandages sewn together -Position: pt. may be supine, SL, or even standing
Soft dressing bandaging should be... Properly tensed including… … decreasing tension distal to proximal … holding hip into extension/adduction with AKA ½ overlapped and void of circular turns and wrinkles
Soft dressing bandaging should be...cont... -Complete and equal coverage including avoiding skin to skin contact i.e. a pinch of skin -Double coverage on distal end -High on inside of groin and lateral glutes with AKA
Post-op dressings extras -Apply dry bandage to dry RL -Wear bandage at all times except for hygiene or treatment purposes -Re-wrap every several hours (4-6 hrs.)
Negative influences -Infection -Smoking -Severity of vascular problems -DM -Renal Disease -Cardiac Disease -Obesity
Positive influences -Earlier rehab -Longer > shorter RL -Unilateral > bilateral amputation -A well-healed, well-shaped RL without scar adhesions -Younger age -Insignificant PMH -Compliance
Prognosis -Increased likelihood of OA:Sound limb- highest; RL -Not as high as sound -Higher in the remaining joints the shorter the RL -Higher likelihood of decreased bone density in RL vs. sound
Created by: alovedaytn