Amputations: Difference between revisions
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'''Original Editor '''- The | '''Original Editor '''- The <a href="Open Physio">Open Physio</a> project. | ||
'''Top Contributors''' - | '''Top Contributors''' - <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="24" _fck_mw_template="true"> | ||
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= Introduction = | = Introduction = | ||
Amputation is 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, wherefetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.<ref | Amputation is 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, wherefetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.<ref>Wikipedia. Amputation. http://en.wikipedia.org/w/index.php?title=Amputation (accessed 29 May 2014).</ref> | ||
== Causes of amputations == | == Causes of amputations == | ||
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*''Congenical limb deficiency'' <ref>Day HJB. The ISO/ISPO classification of congenital limb deficiency. Prosthetics and Orthotics International 1991; 15: 67-69.</ref> | *''Congenical limb deficiency'' <ref>Day HJB. The ISO/ISPO classification of congenital limb deficiency. Prosthetics and Orthotics International 1991; 15: 67-69.</ref> | ||
*''Phocomelia'': "a congenital deformity in which the limbs are extremely shortened so that the feet and hands arise close to the trunk"<ref> | *''Phocomelia'': "a congenital deformity in which the limbs are extremely shortened so that the feet and hands arise close to the trunk"<ref>U.S. National Library of Medicine. Phocomelia. http://www.merriam-webster.com/medlineplus/phocomelia (accessed 29 May 2014).</ref> | ||
=== Acquired === | === Acquired === | ||
| Line 20: | Line 19: | ||
*Vascular | *Vascular | ||
**Ischaemia | **Ischaemia | ||
** | **<a _fcknotitle="true" href="Diabetes">Diabetes</a> | ||
**Frostbite | **Frostbite | ||
**Arterial insufficiency leading to death or decay of body tissue (gangrene) | **Arterial insufficiency leading to death or decay of body tissue (gangrene) | ||
**Chronic leg ulcer leading to | **Chronic leg ulcer leading to <a _fcknotitle="true" href="Septicaemia">Septicaemia</a> | ||
*Malignant tumours e.g. sarcoma (cancer of the connective tissue) | *Malignant tumours e.g. sarcoma (cancer of the connective tissue) | ||
*Trauma | *Trauma (limb buried under / crushed by heavy object, limb damage by car accidenc, stabbing and gunshot, animal bite etc.), in some cases leading to | ||
**''Traumatic amputation: ''a physical separation of the limb in the course of the traumatic event | **''Traumatic amputation: ''a physical (non-surgical) separation of the limb in the course of the traumatic event<ref>Medical Dictionary, the free dictionary. Traumatic Amputations. http://medical-dictionary.thefreedictionary.com/Traumatic+Amputations (accessed 30 May 2014).</ref><ref>U.S. National Library of Medicine. Amputation - traumatic. http://www.nlm.nih.gov/medlineplus/ency/article/000006.htm (accessed 29 May 2014).</ref> | ||
== | == Levels of amputations == | ||
*Upper Limb<img src="/images/8/8b/Faqamp.jpg" _fck_mw_filename="Faqamp.jpg" _fck_mw_location="right" _fck_mw_type="frame" alt="" class="fck_mw_frame fck_mw_right" /> | |||
**Forequarter | |||
**Shoulder Dislocation SD | |||
**Transhumeral (Above Elbow AE) | |||
**Elbow Disarticulation ED | |||
**Transradial (Below Elbow BE) | |||
**Hand and Wrist Disarticulation | |||
**Transcarpal (Partial Hand PH)<br> | |||
*Lower Limb | |||
**Hemipelvectomy | |||
**Hip Disarticulation HD | |||
**Transfemoral TF (Above Knee AK) | |||
**Knee Disarticulation KD | |||
**Transtibial TT (Below Knee BK) | |||
**Ankle Disarticulation | |||
**Symes | |||
**Partial Foot PF (Chopart)<br> | |||
<br> | <br> | ||
== Surgical procedures | == Surgical procedures <br> == | ||
<img src="/images/thumb/d/d7/Amputation.jpg/300px-Amputation.jpg" _fck_mw_filename="Amputation.jpg" _fck_mw_location="right" _fck_mw_width="300" _fck_mw_type="thumb" alt="Transfemoral Amputation" class="fck_mw_frame fck_mw_right" /> | |||
*myodesis: the muscles and fascia are sutered directly to the distal residual bone for better prosthetic control | |||
*myoplastic: suture to opposite muscle in the residual limb to to each other and to the periosteum or to the distal end of the cut bone for weight bearing purposes | |||
== Ideal stump == | == Ideal stump == | ||
| Line 56: | Line 66: | ||
== Location of pulses == | == Location of pulses == | ||
<img src="/images/thumb/b/b9/Femoral_triangle.png/150px-Femoral_triangle.png" _fck_mw_filename="Femoral triangle.png" _fck_mw_location="right" _fck_mw_width="150" _fck_mw_type="thumb" alt="Femoral Triangle" class="fck_mw_frame fck_mw_right" /> | |||
*Foot pulse ( | *Foot pulse (<a href="Tibia#Medial_Malleolus">Medial malleolus</a> or dorsum of the foot) | ||
*Popliteal (behind the knee) | *Popliteal (behind the knee) | ||
*Femoral (within the femoral triangle) | *Femoral (within the femoral triangle) | ||
| Line 65: | Line 75: | ||
== Special investigations == | == Special investigations == | ||
<img src="/images/thumb/5/58/Doppler_ultrasound.jpg/200px-Doppler_ultrasound.jpg" _fck_mw_filename="Doppler ultrasound.jpg" _fck_mw_location="left" _fck_mw_width="200" _fck_mw_type="thumb" alt="Doppler Ultrasound" class="fck_mw_frame fck_mw_left" /> <br> | |||
* | *<a href="X-Rays">X-rays</a> | ||
*CT scan | *CT scan | ||
*Angiogram (outlines blood vessels) | *Angiogram (outlines blood vessels) | ||
| Line 87: | Line 97: | ||
|- | |- | ||
| align="right" | | | align="right" | | ||
| | | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="17" _fck_mw_template="true"> <ref>ladybessviernes, UDM PT Students. Buerger Allen's Exercise. Available from: http://www.youtube.com/watch?v=jQUFmOmX35o [last accessed 01/12/12]</ref> | ||
|} | |} | ||
| Line 101: | Line 111: | ||
=== Balance and gait retraining === | === Balance and gait retraining === | ||
*Improve | *Improve <a href="Balance">static</a> and <a href="Balance">dynamic</a> balance | ||
*Use | *Use <a _fcknotitle="true" href="Parallel bars">Parallel bars</a>, <a href="Zimmer frame">walking frame</a> then <a _fcknotitle="true" href="Crutches">Crutches</a> (in that order) | ||
*Therapist stands on the amp side, using a belt around the patient’s waist to support | *Therapist stands on the amp side, using a belt around the patient’s waist to support | ||
*Rest if the patient feels tired | *Rest if the patient feels tired | ||
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{| width="100%" cellspacing="1" cellpadding="1" | {| width="100%" cellspacing="1" cellpadding="1" | ||
|- | |- | ||
| | | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="14" _fck_mw_template="true"> <ref>Clegstories. Gait Training with C-Leg®: Stance Phase Training. Available from: http://www.youtube.com/watch?v=Xh4rPJFgRx8 [last accessed 08/12/12]</ref> | ||
| | | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="11" _fck_mw_template="true"> <ref>Clegstories. Gait Training with C-Leg®: Swing Phase Training. Available from: http://www.youtube.com/watch?v=E11gQs0oIt0 [last accessed 08/12/12]</ref> | ||
|- | |- | ||
| | | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="8" _fck_mw_template="true"><ref>Clegstories. Clegstories. Gait Training with C-Leg®: Sitting Down and Standing Up. Available from: http://www.youtube.com/watch?v=_lBkrLZ4PGo [last accessed 08/12/12]</ref> | ||
| | | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="5" _fck_mw_template="true"><ref> Clegstories. Gait Training with C-Leg®: Stairs. Available from: http://www.youtube.com/watch?v=Z6bvgDaOkcI [last accessed 08/12/12]</ref> | ||
|} | |} | ||
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|- | |- | ||
| align="right" | | | align="right" | | ||
<img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="2" _fck_mw_template="true"> <ref>Richard Major. Physiotherapy Stump or Residual Limb Wrapping. Available from: http://www.youtube.com/watch?v=T1SA_6hzTxQ[last accessed 08/12/12]</ref> | |||
|} | |} | ||
*For hygiene and skin care see handout on amputations | *For hygiene and skin care see handout on amputations | ||
*A hip flexion | *A hip flexion <a _fcknotitle="true" href="Contracture">Contracture</a> may develop because of elevation to reduce swelling | ||
*Stump bandaging is done to ‘cone’ the stump, thereby preventing oedema, which occurs because there is no muscle pump and the stump hangs | *Stump bandaging is done to ‘cone’ the stump, thereby preventing oedema, which occurs because there is no muscle pump and the stump hangs | ||
*Swelling must be prevented to allow proper attachment of the | *Swelling must be prevented to allow proper attachment of the <a _fcknotitle="true" href="Prosthesis">Prosthesis</a>, and the prevention of <a _fcknotitle="true" href="Pressure sores">Pressure sores</a> | ||
*The stump sock is put on first, then the prosthesis | *The stump sock is put on first, then the prosthesis | ||
*The prosthesis must be cleaned and maintained (Children who are still growing, grow out of their prostheses) | *The prosthesis must be cleaned and maintained (Children who are still growing, grow out of their prostheses) | ||
== | == Mobility aids (instead of or in addition to prosthesis) == | ||
*According to level of fitness, strength, balance etc: | |||
#Walking frame | |||
#Axillary crutches | |||
#Elbow crutches | |||
#Walking stick<br> | |||
For | *For bilateral lower limb amputees a wheelchair in addiction to protheses is indicated (due to high consumption of energy during gait with prostheses) | ||
== Complications == | == Complications == | ||
| Line 150: | Line 165: | ||
Phantom limb pain | Phantom limb pain | ||
== Recent Related Research (from | == Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>) == | ||
<div class="researchbox"> | <div class="researchbox"> | ||
< | <span>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=14QrMe-OFeMCUTROXREO2Goj4A_9ueFIW_SXkIUqFfh4iIHk-X|charset=UTF-8|short|max=10</span> | ||
</div> | </div> | ||
== References == | == References == | ||
<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" /> | |||
<a _fcknotitle="true" href="Category:Amputees">Amputees</a> <a _fcknotitle="true" href="Category:Open_Physio">Open_Physio</a> | |||
Revision as of 13:13, 30 May 2014
Original Editor - The <a href="Open Physio">Open Physio</a> project.
Top Contributors - <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="24" _fck_mw_template="true">
Introduction[edit | edit source]
Amputation is 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, wherefetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.[1]
Causes of amputations [edit | edit source]
Congenital [edit | edit source]
- Congenical limb deficiency [2]
- Phocomelia: "a congenital deformity in which the limbs are extremely shortened so that the feet and hands arise close to the trunk"[3]
Acquired[edit | edit source]
- Vascular
- Ischaemia
- <a _fcknotitle="true" href="Diabetes">Diabetes</a>
- Frostbite
- Arterial insufficiency leading to death or decay of body tissue (gangrene)
- Chronic leg ulcer leading to <a _fcknotitle="true" href="Septicaemia">Septicaemia</a>
- Malignant tumours e.g. sarcoma (cancer of the connective tissue)
- Trauma (limb buried under / crushed by heavy object, limb damage by car accidenc, stabbing and gunshot, animal bite etc.), in some cases leading to
Levels of amputations[edit | edit source]
- Upper Limb<img src="/images/8/8b/Faqamp.jpg" _fck_mw_filename="Faqamp.jpg" _fck_mw_location="right" _fck_mw_type="frame" alt="" class="fck_mw_frame fck_mw_right" />
- Forequarter
- Shoulder Dislocation SD
- Transhumeral (Above Elbow AE)
- Elbow Disarticulation ED
- Transradial (Below Elbow BE)
- Hand and Wrist Disarticulation
- Transcarpal (Partial Hand PH)
- Lower Limb
- Hemipelvectomy
- Hip Disarticulation HD
- Transfemoral TF (Above Knee AK)
- Knee Disarticulation KD
- Transtibial TT (Below Knee BK)
- Ankle Disarticulation
- Symes
- Partial Foot PF (Chopart)
Surgical procedures
[edit | edit source]
<img src="/images/thumb/d/d7/Amputation.jpg/300px-Amputation.jpg" _fck_mw_filename="Amputation.jpg" _fck_mw_location="right" _fck_mw_width="300" _fck_mw_type="thumb" alt="Transfemoral Amputation" class="fck_mw_frame fck_mw_right" />
- myodesis: the muscles and fascia are sutered directly to the distal residual bone for better prosthetic control
- myoplastic: suture to opposite muscle in the residual limb to to each other and to the periosteum or to the distal end of the cut bone for weight bearing purposes
Ideal stump[edit | edit source]
1-skin flaps: skinshould be mobile , sensation is intact , no scars
2-muscles are divided 3 to 5 cm distal to the level of bone resection
3-nerves are gently pulled and cut cleanly, so that they retract well proximal to the bone level to reduce the complication of neuroma
Location of pulses[edit | edit source]
<img src="/images/thumb/b/b9/Femoral_triangle.png/150px-Femoral_triangle.png" _fck_mw_filename="Femoral triangle.png" _fck_mw_location="right" _fck_mw_width="150" _fck_mw_type="thumb" alt="Femoral Triangle" class="fck_mw_frame fck_mw_right" />
- Foot pulse (<a href="Tibia#Medial_Malleolus">Medial malleolus</a> or dorsum of the foot)
- Popliteal (behind the knee)
- Femoral (within the femoral triangle)
- If a leg has been amputated because of gangrene, the remaining leg is examined for a pulse
Special investigations[edit | edit source]
<img src="/images/thumb/5/58/Doppler_ultrasound.jpg/200px-Doppler_ultrasound.jpg" _fck_mw_filename="Doppler ultrasound.jpg" _fck_mw_location="left" _fck_mw_width="200" _fck_mw_type="thumb" alt="Doppler Ultrasound" class="fck_mw_frame fck_mw_left" />
- <a href="X-Rays">X-rays</a>
- CT scan
- Angiogram (outlines blood vessels)
- Doppler ultrasound (occlusion of vessels)
- Venogram and arteriogram
- Radioactive dye injected into the blood
Arterial insufficiency[edit | edit source]
- Surgery to improve circulation
- Bypass grafts (autogenous graft uses a vein to bypass the obstructed area)
- Synthetic grafts
Management[edit | edit source]
Buerger’s exercises[edit | edit source]
| <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="17" _fck_mw_template="true"> [6] |
- Stimulates collateral blood flow in the patient’s leg
- It is performed for 20 min.
- The leg is elevated until the toes go white, then lowered, then level
- Repeat 2-3 times to improve collateral circulation
Connective tissue massage[edit | edit source]
Dynamic stump exercises[edit | edit source]
Balance and gait retraining[edit | edit source]
- Improve <a href="Balance">static</a> and <a href="Balance">dynamic</a> balance
- Use <a _fcknotitle="true" href="Parallel bars">Parallel bars</a>, <a href="Zimmer frame">walking frame</a> then <a _fcknotitle="true" href="Crutches">Crutches</a> (in that order)
- Therapist stands on the amp side, using a belt around the patient’s waist to support
- Rest if the patient feels tired
| <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="14" _fck_mw_template="true"> [7] | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="11" _fck_mw_template="true"> [8] |
| <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="8" _fck_mw_template="true">[9] | <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="5" _fck_mw_template="true">[10] |
Short wave diathermy (SWD)[edit | edit source]
Through the pelvis to warm the arteries (contraindicated in patients with arterial insufficiency because the warmth leads to increased metabolism, causing a greater demand for nutrients, which are not available)
Post-operative care[edit | edit source]
- Maintain function in the remaining leg and stump to maintain peripheral circulation
- Maintain respiratory function (important with smokers and those patients under general anaesthesia)
Stump care[edit | edit source]
|
<img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="2" _fck_mw_template="true"> [11] |
- For hygiene and skin care see handout on amputations
- A hip flexion <a _fcknotitle="true" href="Contracture">Contracture</a> may develop because of elevation to reduce swelling
- Stump bandaging is done to ‘cone’ the stump, thereby preventing oedema, which occurs because there is no muscle pump and the stump hangs
- Swelling must be prevented to allow proper attachment of the <a _fcknotitle="true" href="Prosthesis">Prosthesis</a>, and the prevention of <a _fcknotitle="true" href="Pressure sores">Pressure sores</a>
- The stump sock is put on first, then the prosthesis
- The prosthesis must be cleaned and maintained (Children who are still growing, grow out of their prostheses)
Mobility aids (instead of or in addition to prosthesis)[edit | edit source]
- According to level of fitness, strength, balance etc:
- Walking frame
- Axillary crutches
- Elbow crutches
- Walking stick
- For bilateral lower limb amputees a wheelchair in addiction to protheses is indicated (due to high consumption of energy during gait with prostheses)
Complications[edit | edit source]
Phantom limb pain
Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)[edit | edit source]
References[edit | edit source]
<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" />
<a _fcknotitle="true" href="Category:Amputees">Amputees</a> <a _fcknotitle="true" href="Category:Open_Physio">Open_Physio</a>
- ↑ Wikipedia. Amputation. http://en.wikipedia.org/w/index.php?title=Amputation (accessed 29 May 2014).
- ↑ Day HJB. The ISO/ISPO classification of congenital limb deficiency. Prosthetics and Orthotics International 1991; 15: 67-69.
- ↑ U.S. National Library of Medicine. Phocomelia. http://www.merriam-webster.com/medlineplus/phocomelia (accessed 29 May 2014).
- ↑ Medical Dictionary, the free dictionary. Traumatic Amputations. http://medical-dictionary.thefreedictionary.com/Traumatic+Amputations (accessed 30 May 2014).
- ↑ U.S. National Library of Medicine. Amputation - traumatic. http://www.nlm.nih.gov/medlineplus/ency/article/000006.htm (accessed 29 May 2014).
- ↑ ladybessviernes, UDM PT Students. Buerger Allen's Exercise. Available from: http://www.youtube.com/watch?v=jQUFmOmX35o [last accessed 01/12/12]
- ↑ Clegstories. Gait Training with C-Leg®: Stance Phase Training. Available from: http://www.youtube.com/watch?v=Xh4rPJFgRx8 [last accessed 08/12/12]
- ↑ Clegstories. Gait Training with C-Leg®: Swing Phase Training. Available from: http://www.youtube.com/watch?v=E11gQs0oIt0 [last accessed 08/12/12]
- ↑ Clegstories. Clegstories. Gait Training with C-Leg®: Sitting Down and Standing Up. Available from: http://www.youtube.com/watch?v=_lBkrLZ4PGo [last accessed 08/12/12]
- ↑ Clegstories. Gait Training with C-Leg®: Stairs. Available from: http://www.youtube.com/watch?v=Z6bvgDaOkcI [last accessed 08/12/12]
- ↑ Richard Major. Physiotherapy Stump or Residual Limb Wrapping. Available from: http://www.youtube.com/watch?v=T1SA_6hzTxQ[last accessed 08/12/12]
