Amputations

Question 1

Amputation

Answer 1

• the removal of a limb or part of a limb due to trauma, disease, or surgical intervention

Question 2

Major amputation levels

Answer 2

• below elbow
• above elbow
• below knee
• above knee

Question 3

Etiology of amputations

Answer 3

• trauma (ex: accidents, war injuries)
• peripheral vascular disease (PVD)
• diabetes mellitus complications
• infections (ex: osteomyelitis = an infection/bacteria that eats away your bones)
• tumors (ex: osteosarcoma/cancer)
• congenital conditions

Question 4

Peripheral artery disease (PAD)

Answer 4

• a common circulatory problem in which narrowed arteries reduce blood flow to the limbs
• increases the risk of developing non-healing wounds on the legs or feet

Question 5

Etiology and risk factors of PAD

Answer 5

• atherosclerosis = build-up of plaque in the arteries
• smoking, diabetes, hypertension, and high cholesterol
• age = more common in people over age 50
• family history of cardiovascular disease

Question 6

Signs and symptoms of PAD

Answer 6

• leg pain or cramping, especially when walking or exercising (intermittent claudication)
• numbness or weakness in the legs
• coldness in the lower leg or foot
• sores on toes, feet, or legs that won’t heal

Question 7

Diagnosis and management of PAD

Answer 7

• ankle-brachial index (ABI) test = compares the blood pressure in the ankle with the blood pressure in the arm (low ankle-brachial index number can mean there is narrowing or blockage of the arteries in the legs)
• Doppler ultrasound, angiography
• lifestyle modifications = smoking cessation, exercise, and diet changes
• medications to manage symptoms and improve blood flow
• surgical interventions = angioplasty, stunting, or bypass surgery

Question 8

Foot ulcers

Answer 8

• as a result of the disease, they can’t feel it or take care of it, the wound is just there, causing an ulcer
• leads to potentially an amputation

Question 9

Conservative management to PAD treatment

Answer 9

• medicine and lifestyle changes
• foot and leg wound care
• minimally invasive procedures (balloons, stents, and other devices to restore blood flow to an extremity)
• surgical revascularization = open surgical techniques like limb bypass (to reroute blood supply around a blocked artery) and endarterectomy (removal of plaque from the artery)
• amputation
  *really once the patient gets an amputation, they actually move on with their life just fine, as opposed to trying to live with the infection for months or years

Question 10

Diagnostic criteria and evaluation of PAD

Answer 10

• clinical examination and history taking
• imaging = x-rays, MRI, and CT scans for trauma or tumor evaluations
• vascular studies for determining blood flow (ex: Doppler ultrasound)

Question 11

Amputation surgery

Answer 11

• traumatic amputation = the incision line is not pretty
• amputation repaired (being conducted) = can be more precise and have more control to create an incision line (will leave some extra skin if possible to leave extra skin to flip it over to cover the wound
• wound vac = when not have enough skin and having to leave an opening

Question 12

Medical and surgical management of amputations

Answer 12

• pre-surgical management = infection control, pain management, and psychological preparation
• post-surgical care = pain management, wound care, and prevention of complications like contractures

Question 13

Post amputation management

Answer 13

Physical symptoms:
- pain = phantom limb pain, residual limb pain
- swelling and bruising
- limited range of motion
Psychological symptoms:
- depression
- anxiety
- body image disturbances

*when it’s below elbow or below knee, you can get the elbow or knee to stay in a bent position because it’s more comfortable to do that

Pain management:
- stump pain management
- phantom limb pain management
- musculoskeletal pain and disorders
Stump and prosthesis:
- stump and prosthetic hygiene
- fitting of the prosthesis
- the various types and use of prostheses
Psychosocial:
- bereavement of the lost limb
- depression management
- changes in social life
- societal perceptions of amputees
Daily needs:
- transportation
- couple relationships
- activities, return to work and sports
- fall prevention

Question 14

Phantom pain

Answer 14

• pain that feels like it’s coming from a body part that is no longer there
• central nervous system remapping = brain areas previously responsible for the amputated limb may still produce pain signals
• peripheral nervous system = neuromas at the amputation site may trigger phantom pain
• sensations of burning, throbbing, stabbing, or shooting pain in the amputated limb
• pain may be triggered by changes in weather, pressure on the residual limb, or emotional stress

*people fall a lot after the amputation, especially with the leg amputated as they still think it’s still there

Question 15

Management strategies to phantom pain

Answer 15

• medications = antidepressants, anticonvulsants, or opioids
• non-pharmacological interventions = mirror therapy, graded motor imagery, transcutaneous electrical nerve stimulation (TENS)
• psychological interventions = cognitive-behavioral therapy (CBT) and mindfulness techniques
• physical therapy = desensitization exercises and massage of the residual limb

Question 16

Course and prognosis of amputations

Answer 16

Typical progression:
- immediate postoperative recovery
- rehabilitation phase = physical and occupational therapy
- long-term adjustments = prosthetic fitting, lifestyle adaptations
Factors affecting prognosis:
- comorbid conditions (ex: diabetes, cardiovascular disease)
- age and overall health
- psychological adaptation

Question 17

Pre-prosthetic management

Answer 17

• after the amputation, the wound is healing
• months of a long process = pre-prosthetic training
• figure 8 wrapping = you do this before the wound is closed, once the wound is closed, you use socks as a stump shrinker
• working on edema and shrinking the stump
• stump compressor (like a sleeve)

Question 18

Prosthetic management

Answer 18

Types of prostheses:
- body-powered prostheses = your body does the work (ex: using the scapula to active the pulley system in the arm prostheses for the claw to close
- myoelectric prostheses = use electrodes in the sockets and the muscles you have left as they contract and it moves the prosthetic arm or leg
- cosmetic prostheses (passive)
Selection criteria:
- based on the level of amputation, patient goals, and functional needs

Question 19

Suspension options

Answer 19

• strap suspension
• pin suspension
• suction and snug fit (silicone suction)

*socket = the part your residual limb (stump) goes in

Question 20

Occupational implications of amputations

Answer 20

• looking at two components = when doing their ADLs and IADLs with and without prostheses
• ADLs and IADLs = dressing, grooming, and feeding adaptations
• work and leisure activities = ergonomic adjustments, workplace modifications, and adaptive equipment for leisure participation
• psychosocial impact = strategies for coping with changes in body image and self perception