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Flashcards in Exam 1 Review Deck (47)
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1

Surgical Techniques for amputation (3)

  • Myoplasty: attach muscle to muscle
    • Better for patients with vascular problems
    • performed between the agonist and antagonist muscle groups) reestablishing a muscle pumping action
    • gives greater control to the limb and adds a muscle padding over the end of the limb.
  • Myodesis: Attach Muscle to periosteal bone
    • not recommended for ischemic patients
    • causes bone trauma
  • Myofascial: Attach muscle to fascia

2

Causes of amputation (6)

  • Peripheral vascular disease
    • most common cause of amputation in adults
  • Diabetes
  • Trauma
  • Infections
  • Tumors
  • Limb deficiencies

3

Evaluating blood flow (techniques):

1. Auscultation via a stethoscope

2. Palpation

3. Doppler Ultrasound Blood Pressure

  • most readily available objective measure of blood flow and perfusion
  • used to detect both arterial and venous blood flow

4. Impedance plethysmography

  • Often used to detect DVT

 

 

4

In a straight vessel blood flow is termed _______. In a diseased vessel with plaque formation, blood flow has a higher velocity through the occlusion. Distal to the occlusion blood flow is _________.

-- laminar

-- turbulent

5

Factors that determine level of amputation:

1. Adequate circulation

2. Save as much length as possible while removing all non-viable tissue

3. A residual limb that allows a pain free return to functional activity

6

A residual limb that is very short may be:

Difficult to fit

7

A residual limb which is very long (trans-tib) may be:

Prone to circulatory problems

8

Saving as much length and as many joints as possible allows:

-- ↑ amount of surface area for suspension

-- ↓ rotation of knee units and foot/ankle components

-- Leaves more of the adductor longus attachment to minimize contractures

-- Creates a longer limb for sitting and transfers

9

Too long transfemoral amputation:

  • Makes padding the residual limb more difficult
  • Leaves less room for prosthetic components
  • Difficulty matching leg length to prosthetic knee center

10

To Prevent neuromas

Resect nerves under gentle traction

11

Minimize soft tissue trauma from sharp or irregular bone edges

Bevel bone ends

12

To improve function and shape

  • Muscle fixation
  • Fibula ~ 1cm shorter than tibia

13

Suture line should:

...avoid bony prominences and the distal end

14

Transtibial amputations often use this closure:

Long posterior flap

  • provide better vascular supply

15

Transfemoral Amputation commonly use this closure:

Fishmouth

  • Equal length posterior/anterior flaps

16

"Problems" with closures:

  • Dog ears
  • Adherent scars
  • Neuromas

17

Post-operative complications (Co-morbidities):

  • Wound infections
  • Cardio-vascular
  • DVT
  • Decubiti

18

Residual limb shapes (3):

  1. Conical 
  2. Cylindrical
    • Cylindrical shape is better suited for total contact prosthetic fitting devices
  3. Bulbous

19

Skin sensation may be assessed using

Semmes-Weinstein filaments

  • If a patient cannot consistently feel the touch of a 5.07 filament, the protective sensation has been lost

20

Skin Inspection of the residual limb:

  • scar adherence
  • coolness
    • possible arterial insufficiency
  • abnormal warmth
    • possible infection
  • impaired sensitivity

21

Phantom Limb Pain vs. Phantom Limb Sensation

  • Phantom pain is characterized by a perception of pain in the absent distal extremity
    • Often desribed as shooting, burning, stabbing or crushing

 

  • Phantom Limb Sensation is a perception of the absent distal extremity

22

Components of an evaluation of a patient with amputation:

  • DEMOGRAPHIC INFORMATION
  • FUNCTIONAL ASSESSMENT
  • TESTS & MEASURES OF RESIDUAL LIMB
  • TEST & MEASURES OF INTACT LIMB

23

Components of the functional evaluation:

  • Ambulation
  • Transfers
  • Bandaging/Use of a shrinker

24

TESTS & MEASURES OF RESIDUAL LIMB
 

  • LENGTH
  • CIRCUMFERENCE
  • SHAPE
  • APPEARANCE
  • ROM
  • STRENGTH
  • STABILITY
  • SKIN

25

TEST & MEASURES OF INTACT LIMB
 

  • STRENGTH
  • ROM
  • CIRCULATION
  • TEMPERATURE
  • SKIN
  • HAIR ON EXTREMITY

26

Prosthetic/orthotic clinical procedure

  • PRE-PRESCRIPTION
    • PT (EVAL)
  • PRESCRIPTION
    • MD ONLY
  • PREFITTING
    • PT (WRAPPING, THEREX, ROM)
  • FABRICATION
  • INITIAL EXAM
  • TRAINING
    • PT (GAIT)
  • FINAL EXAM
    • PT

27

Medicare Reimbursement Levels

  • 0 = No potential to ambulate/transfer with or without assistance
  • 1 = Potential to ambulate/transfer with fixed cadence in home
  • 2 = Potential to ambulate/transfer in low level environmental barriers
  • 3 = Potential to ambulate/transfer with variable cadence in community
  • 4 = Potential to exceed basic ambulation skills with high impact activities

28

Cost is determined by:

  • sophistication of the components
  • types of materials used for construction
  • Costs of transtibial prostheses range:
    • 4,000 to 16,000 dollars
  • Costs of transfemoral prostheses range
    • 5,500 to 40,000 dollars

29

Stages of Adjustment (Traumatic)

  • Shock
  • Anxiety
  • Denial
  • Depression
  • Anger
    • Toward self
    • Toward others
  • Acceptance
  • Adjustment

30

Stages of adjustment (elective)

  • Preoperative Stage
    • realization that limb loss is a possibility
    • grief
    • concerns about pain
  • Immediate Postoperative Rehab Stage
    • realization that normal level of function is no longer possible
    • Denial replaces grief
    • euphoric mood, regression, withdrawal
  • Return Home Stage
    • Mixed reactions
      • leaving hospital means recovery
      • faced with lack of help available at hospital
    • Reorganization of how the individual views oneself and the world and attempts to regain maximal functional potential