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S3- Amputation And Prosthetics > Surgical Techniques And Outcomes; Psychosocial Issues > Flashcards

Surgical Techniques And Outcomes; Psychosocial Issues Flashcards

1
Q

What are the 3 most common levels of lower extremity amputation called?

A
  • Transmetatarsal (midfoot)
  • Transtibial (below knee)
  • Transfemoral (above knee)
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2
Q

Disarticulation amputations occur at what level?

A

Level of the joint (hip, knee, and ankle disarticulations

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3
Q

4 Factors affecting level of amputation:

Vascular disease
-Level selected based on anticipated viability for ________ healing.

Postoperative function is considered
-Most _______ level possible.

Disarticulations
-Most surgeons won’t perform disarticulation at knee or ankle due to concern that poor __________ may interfere with healing.

Traumatic amputation
-Level determined based on _______ of injury and _______ of tissue.

A
  • tissue
  • distal
  • circulation
  • nature, viability
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4
Q

What is the goal of amputation?

A

Save as much limb length as possible.

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5
Q

What are the 2 main general surgical principles of amputation?

A
  • Myoplasty

- Myodesis

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6
Q

What is myoplasty?

A

Attachment of anterior and posterior compartment muscle to each other over the end of the bone.

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7
Q

What is myodesis?

A

Anchoring of muscles to bone.

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8
Q

Myoplasty vs. Myodesis:

  • Which increases stability and muscular control?
  • Which is better in the presence of ischemia?
A
  • Myodesis

- Myoplasty

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9
Q

In amputations, large nerves are pulled down and resected sharply so they retract into the sharp tissue, what does this prevent?

A

Neuromas - Thickened area of nerve tissue that are sensitive to pressure (interpreted as pain).

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10
Q

Skin flaps are as broad as the distal end of the limb and are shaped to allow corners to retract smoothly. Drains are utilized just under incision for removal of excess fluid and are removed after __-__ days.

A

1 to 2

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11
Q

In regards to skin flaps, when are amputations kept open?

A

If infection is present or not enough tissue to provide good closure.

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12
Q

What are the 2 main ways skin flaps are used for closed amputations?

A
  1. ) Equal length anterior/posterior flap

2. ) Long posterior flap

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13
Q

Equal length anterior/posterior flap is used when conserving _________ or when primary healing is not a concern. Flaps are shaped to reduce “________” at corners.

A
  • bone length

- “dog ears”

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14
Q

Long posterior flap is used when _________ is of concern or when more padding is needed.

A

vascularity

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15
Q

What is a 3rd less common way skin flaps are used for closed amputations?

A

Skew sagittal flaps

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16
Q

Skew sagittal flaps are used in severe _________ cases and takes advantage of ________ nerve/artery, and ______ nerve. This helps with blood flow ________.

A
  • dysvascular
  • saphenous
  • sural
  • laterally
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17
Q

Transtibial (below knee) desireable length is controversial:

  • Some advocate for bone length to help with _____.
  • Others argue that long bone length increases chance for development of distal _____ problems as well as __________ tissue.
A
  • gait

- skin, nonvascular

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18
Q

As a transtibial amputation gets closer to the knee, the ______ develops a mechanical advantage over the quad which can result in what?

A
  • hamstrings

- knee flexion contractures, and difficult to extend knee (esp during swing phase)

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19
Q

What is the shortest level of amputation that is compatible with knee function?

A

tibial tubercles

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20
Q

In general, fibula is cut _cm shorter than the tibia for limb shaping. The tibia and fibula are also beveled to prevent soft tissue ___________.

A
  • 1cm

- impingement

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21
Q

Transfemoral (above knee) is historically the most common level for individuals with poor ________ or _______ of the foot/ankle.

A
  • circulation

- gangrene

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22
Q

Does a transtibial or transfemoral amputation require more energy to ambulate with a prosthesis?

A

Transfemoral

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23
Q

What are 3 reasons for choosing transfemoral over transtibial amputation?

A
  • Trauma
  • Gangrene extended into knee
  • Circulatory status indicating poor chance of healing at transtibial level
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24
Q

In transfemoral amputations, maintanence of the __________ shaft axis as close to normal as possible is critical:

  • Difficult secondary to loss of __________ attachment
  • Surgeons suggest __________ of adductor magnus to femur at the level of the amputation for maintaining more normal alignment.
A
  • femoral
  • adductor
  • myodesis
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25
Q

During surgery of a transfemoral amputation, the limb is maintained in ________ and _______ to maintain proper tension and alignment.

A
  • extension

- adduction

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26
Q

What are the skin flap techniques used for transfemoral amputations?

A
  • Equal length

- Long medial flap in sagittal plane

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27
Q

Common Issues Post-op (All Amputations)?

A
  • Pain
  • Wound healing
  • Fluid collection/edema
  • Heterotrophic ossification
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28
Q

Common Issues Post-op (Transtibial)?

A

Knee flexion contracture

29
Q

Common Issues Post-op (Transfemoral)?

A
  • Hip adductor roll
  • Hip flexor contracture
  • Hip abduction contracture
  • Glute weakness
30
Q

As the length of the femur decreases in an amputation, we have a much higher increased likelihood of hip __________ contracture due to the compromised power of the _______ muscles.

A
  • abductor

- adductor

31
Q

What is osseointegration?

A

Direct structural and functional connection between the surface of implants and living bone tissue percutaneously connected to a prosthetic limb.

32
Q

What are the benefits of osseointegration?

A
  • Eliminates need for a socket
  • Short residual limb
  • More natural feeling
  • Improved gait
  • Allows for normal swelling
33
Q

What are the downsides of osseointegration?

A
  • Multiple surgeries
  • Prolonged period of no ambulation
  • Risk of fracture, infection
  • Reduction in activities that require high torque or axial stress
  • Not well known in the U.S.
34
Q

What is hemicorporectomy?

A

Below waist amputation, both LE amputated.

35
Q

What is transpelvic amputation?

A

Amputation of portion of the pelvis and LE.

36
Q

What is hip disarticulation?

A

Amputation through hip joint capsule including the entire LE.

37
Q

When are hemicoprectomy, transpelvic, and hip disarticulations performed?

A

Usually performed to save the life of the patient.

  • Malignancy
  • Severe infection/gangrene
  • Severe trauma
38
Q

What is the goal of hemicoprectomy, transpelvic, and hip disarticulations?

A

Provide patient with good soft tissue flap for pressure tolerance for comfort with sitting.

39
Q

Indications for Knee Disarticulation:

  • Inability to provide adequate transtibial residual limb secondary to trauma
  • Knee flexion contracture >__ degrees,
  • ________ of soft tissue close to knee joint
  • __________ deformities
A
  • 45 degrees
  • Infection
  • Congenital
40
Q

Are knee disarticulations used in individuals with vascular compromise?

A

Rarely, because typically disarticulations don’t have good vascular supply.

41
Q

Ankle disarticulation (Symes) Amputations are through the ankle preserving the __________. They are used for severe foot trauma, congenital abnormalities, or gangrene of the forefoot.

A

heel pad

42
Q

Is circulation to the heel pad required for ankle disarticulation to be successful?

A

Yes

43
Q

Heel pad is closely adhered to end of tibia:

  • Prevents movement between heel pad and bone that may result in ______ and ineffective prosthetic fit.
  • _________ common immediately after to allow heel pad to heal.
A
  • pain

- casting

44
Q

Transmetatarsal amputations are a removal of the toes and distal ends of the __________. It is important to salvage as much metatarsal length as possible.

A

metatarsals

45
Q

Transmetatarsal amputations are mostly performed secondary to _________ due to dyscascularity or diabetes. Also can come from _________ causes.

A
  • infection

- traumatic

46
Q

What are 2 other through the foot amputations?

A
  • Lisfranc (tarsometatarsal disarticulation)

- Chopart (midtarsal disarticulation)

47
Q

Main Takeaways:

  • Reason for amputation is key for treatment
  • Level and amputation type are important for _____________
  • Limb _______ is vital to prosthetic use, and therefore function
  • Expect impairments in muscle length, strength, and motor control following amputation surgery
  • Don’t forget about ______________
A
  • rehabilitation
  • shape
  • co-morbidities
48
Q

PSYCHOSOCIAL ISSUES

A

PSYCHOSOCIAL ISSUES

49
Q

What is the role of a PT in regards to phsychosocial issued steming from amputation?

A
  • Recognize the effects of changes in body image.

- Help facilitate adjustment to change.

50
Q

The effect of change in body image is related to what?

A
  • How well the individual can continue to pursue previous activities.
  • Whether change occurred gradually or suddenly.
51
Q
  • The most significant factor for positive adjustment to amputation is premorbid _______ mechanism.
  • It is also dependent on what 3 things?
A

-coping

  • Amputee experience: comfort, cosmesis, vocational, social
  • Amputee behavior: are they using the part
  • Amputee psychodynamics: perception of disability, ego, frustration
52
Q
  • Is depression and anxiety common in the amputee population?
  • Many present with _______ and _______ which are negative coping strategies.
A
  • Yes

- avoidance and denial

53
Q

What are the 4 stages of emotional adjustment to amputation?

A
  • 1st prior to surgery
  • Immediatly after surgery
  • After initiation of postoperative program
  • Reintegration into functional lifestyle
54
Q

Stage 1 of emotional adjustment is Initial _____.

  • _____ to surgery
  • Utilize more ________ responses
A

Shock

  • prior
  • reflective
55
Q

Stage 2 of emotional adjustment.

  • _________ surgery
  • Relief and ______ are possible.
A
  • Immediately after

- grief

56
Q

Stage 3 of emotional adjustment is ___________.

  • ________ program
  • Younger indivduals may _____, men often fear negative implications of ________ activity.
  • Overwhelming with ________ may lead to greater helplessness
A

Acknowledgement

  • Post-op
  • deny, sexual activity
  • information
57
Q

Stage 4 of emotional adjustment is ___________.

  • Reintegration into _________ lifestyle
  • Various concerns regarding prosthesis including _______, _________, and ___________ expectations.
A

Adaptation

  • functional
  • appearance, functionality, unrealistic expectations
58
Q

_______ issues are concerns that are often left unattended.

A

Sexual

59
Q

What is phantom sensation?

A

Sensation that the absent limb is still there in some form.

60
Q

Phantom sensation is usually experienced after surgery and presents as ______, pressure, and sometimes _________.

A
  • tingling

- numbness

61
Q

In phantom sensation, the most _____ part is felt most frequently and occurs in majority of individuals and may last for _______.

A
  • distal

- years

62
Q

Is phantom pain the same as phantom sensation?

A

No, it is described as cramping or squeezing sensation, shooting or burning pain that is felt in the amputated limb.

63
Q

Phantom pain can be ________ or diffuse; continuous or __________. Phantom pain may diminish or may become permanent.

A

-localized, intermittent

64
Q

What is utilized to treat phantom pain?

A

Mirror box system/therapy

65
Q

Age Considerations-Children:

  • _________ adjustment is important because greatly influences the child’s adjustment
  • Children adapt fairly ______ to the use of orthotic or prosthetic
  • Important that parents treat the child “_________”
A
  • parental
  • easily
  • normal
66
Q

Age Consierations- Elderly:

  • Critical issue: maintaining __________
  • May be viewed as the end to an _______ lifestyle
  • Learning to use artificial limb or orthosis may be slow and __________
  • Consider ____________
  • Important to allow the individual to have as much control as possible
A
  • independence
  • active
  • discouraging
  • comorbidities
67
Q

Considerations: Caregivers

  • Can be stressful for caregivers as well
  • Can they _________ handle caring for the patient
  • Provide time for caregiver to ask questions (may need to increase _________ in caregiver skills)
A
  • physically

- confidence

68
Q

Main Takeaways:
-Complex issues require ______ approach
-Pre-amputation _________ mechanism can determine psych outcome
Not just the patient
Children adjust quickly, but __________ can be an issue throughout teen years

A
  • team
  • coping
  • compliance

S3- Amputation And Prosthetics (10 decks)

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