65. amputation

Question 1

indications of amputations

Answer 1

1. tumor (OSA)2. severe trauma3. peripheral nerve dz (dysfunction, self mutilation)4. thromboembolic disease (ischemia)5. severe infection6. severe dysability (OA)contraindications: obesity and concurrent ortho/neuro dz

Question 2

general principles for limb amputation

Answer 2

1. multimodal analgesia (injectable, local nerve block, +/- wound catheter, epidural)2. hemostasis (ligation, cautery)3. total limb amputation4. skin incision considerations5. Wound closure

Question 3

ligation considerations of major arteries and veins for limb amputations

Answer 3

nonabsorbable or absorbabledouble ligate artery and vein(artery first to prevent pooling, vein first to prevent metastasis if neoplasia)

Question 4

Conclusion to 2009 Vet Anesth Albeson et al paper of 56 cases with wound soakers

Answer 4

Incisional infections were noted in 3/56 (5.3%) limb amputations with wound soaker catheters placed which was not statistically higher than the incisional infection rate found in the historic control cases 3/20 (15%)

Question 5

options and pros/cons of the methods for thoracic limb amputation

Answer 5

1. disarticulation–time consuming, leave scapula which leads to muscle atrophy and potential P sores 2. forequarter amputation–easier, faster, no bone left, potential for less thoracic chest protection from trauma (bogus)

Question 6

options and pros/cons of the methods for pelvic limb amputation

Answer 6

1. disarticulation–subjectively better function2. mid diaphseal osteotomy of femur–protects the male genitalia, carry unnecesary weight, muscle atrophy and P sores3. acetabulectomy (especially for cases where neoplasia crossing joint–not common)

Question 7

Complications of amputation

Answer 7

hemorrhageseroma formationdehiscenceinfectionneuromcervical disc herniation–head bobbing stress in spine phantom painchange in gait is expected–more pronounced in forelimbs