The majority of LE amputations are caused by _______
vascular disease
The majority of UE amputations are due to ________
trauma
List various causes of amputations
In order from most to least likely
- Diabetes and PAD (dysvascular disease)
- Trauma
- Cancer
- Congenital deficiences
How can diabetes result in a LE amputation?
- elevated blood sugar causes damage to blood vessels and nerves
- results in periperal neuropathy
- results in loss os protective sensation
- blister or minor injury occurs
- develops to an ulcer
- amputation
List the clinical signs of peripheral neuropathy
- Deficits in sensation
- motor impairments
- autonomic dysfunction
- tropic changes
How are deficits in sensation related to amputation?
makes the patient more vulnerable to high-pressure and repetitive low-pressure traumas
Other than peripheral neuropathy, list other diabetic complications that can lead to amputation.
- Severe ischemic pain
- absent pulse → called arteriosclerosis obliterans
- local necrosis
- osteomyelitis
- systemic toxicity
- acute embolism
- DVT
List the classic symptoms of PAD
- intermittent claudication
- Arteriosclerosis obliteran →loss of one or more LE pulses
what is intermittent claudication and how can we test for it?
leg pain brought about by activity and resolved with rest
test using a walking test
List risk factors for PAD
- poorly managed HTN
- high cholesterol and triglyceride levels
- history of tobacco use
*stroke and CVD also share these risk factors
How do we prevent limb loss in diabetic patients?
- provide all diabetic patients with a comprehensive foot screen
- provide daily foot checks
- teach patients how to perform daily foot checks
what is included in a comprehensive diabetic foot screen?
tests for:
- protective sensation (monofilament, sharp/dull testing)
- skin temp
- distal pulses
- visual observations for:
- nail shape and color
- deformities
- swelling
- callus formation
what are the leading causes of trauma that result in a LE amputation?
- MVA
- farming accidents
- power tools
- firearms
- burns and electrocutions
List various challenges unique to traumatic amputations
- limb length and shape can vary due to the trauma
- parital vs full amputation
- multiple surgeries usually required
- tissue viability and loss
- pain
- other injuries may take priority like CNS injuries
what are clinical symptoms for osteosarcoma?
- pain w/weightbearing
- Hx of worsening, deep local pain
- fractures
T/F: there is an overall decreasing need for amputations in osteosarcoma patients
TRUE
medical field getting better at early screening and treating
what is the prevelance of congenital deformities resulting in amputation?
accounts for less than 1% of amputations
7.9 per 100,000 live births
what are unique challenges presented by congenitial deficiency amputations?
- rapid growth
- cosmesis
- must be provided for function in order to meet developmental benchmarks
