Beruflich Dokumente
Kultur Dokumente
including:
Naming the systems affected,
Describing their commonalities, and
Enumerating their common clinical
manifestations
Describe briefly the classification systems
Objectives
Objectives
Objectives
Objectives
Objectives
Objectives
Objectives
Definition
Amputation
From Wikipedia.org:
The removal of a body extremity by trauma,
prolonged constriction, or surgery.
As a surgical measure, it is used to control
pain or a disease process in the affected limb,
such as malignancy or gangrene.
In some cases, it is carried out on individuals
as a preventative surgery for such problems.
A special case is that of congenital
amputation, a congenital disorder, where fetal
limbs have been cut off by constrictive bands.
Classification
As to Cause
Acquired amputations
Loss of part or all of an extremity as the direct
result of trauma or by surgery.
It is also done to revise a congenital limb amputation
Congenital amputations
Loss of a limb in utero and are believed to
result from such stimuli as drug toxicity.
There is failure of formation or strangulation of limb
Classification
Longitudinal deficiency
Names the bones affected, and indicates
whether the bones are partly or totally
affected.
Classification
Classification
Classification
As to Level
See Appendix A (Levels of Amputations)
Epidemiology
Generally:
5:1 Ratio of lower limb to upper limb
Epidemiology
As to cause:
Peripheral Vascular Disease (PVD)
PVD without diabetes ranges 2-5% among
individuals
PVD with diabetes ranges 6-25%
7-13% usually is associated with other
medical problems such as cardiac dose and
stroke
caused by a number of underlying pathologies
of the arterial, venous or lymphatic systems,
including occlusion, inflammation, vasomotor
dysfunction or neoplasms
Epidemiology
As to cause:
Trauma
75% of acquired amputation in UE
primarily men aged 15-45 yrs. Old
next most common cause for LE amputation
about 20%
Epidemiology
As to cause:
Disease and Tumors
responsible for about equal number of the
remaining acquired UE amputations
in LE, it accounts approximately 75% of all
acquired amputations among 60 years and
above
it is the most frequent cause of all amputation
in both the UE and LE among children aging
10-20 yrs. old
Epidemiology
By Age Range:
1st year of life
Congenital deficiencies
1 to 10 years of age.
Motor vehicular accidents, tumor and
trauma.
10 to 20 years of age
Malignancy is the most common cause.
55 years of age
Peripheral vascular disease
Etiology
Trauma
Neoplastic Tumors
Peripheral Vascular Disease
Congenital Anomaly
Thermal, Chemical, or Electrical Injury
Infection
Other
Pathophysiology
Trauma
Amputation is done where blood supply or
Pathophysiology
Neoplastic Tumors
result from disruption in the control mechanism
Pathophysiology
Pathophysiology
Congenital Anomaly
refers to the absence or abnormality of a
part
Infection
i.e. chronic osteomyelitis, gas gangrene of
high virulence
Pathophysiology
Other
Punitive
Self-inflicted
Cultural
Pathophysiology
Clinical Manifestations
residual limb
joint contractures occur between the time of
amputation and prosthesis fitting
amputees on chemotherapy have residual
limb volume fluctuation
diabetic patients not only experience
vascular compromise, but also suffer motor,
sensory, 2 neuropathy, all of which lead to
ulceration
Complications
Abnormal Sensations
Phantom Pain
Phantom Limb
Residual Limb Pain
Complications
Skin Problems
Choke Syndrome
Verrucous Hyperplasia
Skin Infection
Contact Dermatitis
Bone Problems
Bone Spurs
Bone Hypermobility
Neuromas
Diagnosis
History
Physical examination
Stump
Skin
Muscles
Bones
Nerves and vascular structures
Nearby areas
Cardiovascular/Pulmonary Status
Differential Diagnosis
Differentiate as to:
Cause
Level
Type of surgery performed
Etc.
Prognosis
Poor
Ideal
Age
Older
Younger
Smoking
Smoker
Non-smoker
Co-morbid Conditions
Present
Absent
Infections
Present
Absent
Severity of pre-operative
condition
Uncomplicated
General Principles:
Surgeon removes part or all of the limb
type of amputation is at the discretion of the
surgeon and the extent of the extremity at the
time of the amputation.
Allow for 1 or 2 wound healing
Construct a residual limb for optimum
SKIN FLAPS
BLOOD VESSELS
BONE ENDS
DRAINS
Approaches
healing is enhanced by
gentle handling of the residual limb,
controlling residual limb edema through rigid,
semi-rigid, or soft compression dressings, and
using aseptic techniques in wound care to
avoid infection
General Healthcare
Management
Physical Therapy
Examination