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Amputation of the lower limb .

brief description on amputations, the levels and the causes

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Amputation Amputation  Amputation is an acquired condition that results in the loss of a limb, usually from injury, disease, or surgery
Facts about amputation Facts about amputation  90% of all amputation are lower limb  77% are Males  50% between 21 – 65 years old  Currently number one cause is vascular  50% of vascular amputation are caused by diabetes  80% of diabetic amputations are over 50 years  Majority of diabetic amputations are preventable
Reasons for amputation Reasons for amputation  Vascular diseases  Congenital abnormalities (radiations)  Infections  Trauma  Tumors
Care during amputation Care during amputation  To achieve a non-sensitive residual limb  To achieve weight bearing capabilities  Treatment of the distal bony end  Appropriate treatment the blood vessels  Appropriate treatment of the nerves  Appropriate suture lines  Appropriate location of scars
Common Lower limb amputation levels  Transmetatarsal Chopart  Symes Transtibial  Knee Disarticulation  Transfemoral  Hip Disarticulation  Hemipelvectomy  Hemi-corporectomy
Amputation through the midsection of the metatarsals. It is usually indicated for gangrene and infections. Shoe modifications and inserts will be required. Weight bearing problems may surface, and will need follow-up over time Transmetatarsal
Amputation removing the forefoot and midfoot, leaving the talus and calcaneus. Often a prosthesis or AFO is needed Chopart
Ankle disarticulation with attachment of heel pad to distal end of tibia. Gait problems minimized with prosthesis. The prosthesis is designed to balance and relieve weight bearing Symes
Below the knee amputation. Amputation through the tibia and fibula with knee left intact. Careful consideration to weight bearing is given. Transtibia
Amputation through the knee joint with the femur intact. Knee disarticulation
Above the knee amputation. Amputation through the femur. Weight bearing with prosthesis is also important Transfemoral
Amputation through the hip joint, leaving the pelvis intact. Usually performed for malignant disease. Hip Disarticulation
Resection of half of the lower pelvis Hemipelvectomy
Amputation of both limbs and pelvis Hemi-corporectomy
Psychological / motivational effects  Residual limb (stump) condition  Change of center of mass support  Change from physiological weight transfer surfaces to non-physiological ones  Loss of feedback and physiological control loops  Loss of joint stabilization General side effect of amputation
 Loss of active joint motion control  Need to re-learn the process of standing and walking  Need to switch from subconscious, automated control and motion patterns to highly conscious and completely new patterns of stability-control (which means safety!) and motion. General side effect Cont…
 Parameters for a healthy good stump is considered to have the following:  A well healed stump  Of a reasonable lever arm length ( the longer the better)  Of healthy skin condition ( minimum scarring,  Of good general soft tissue coverage  Free of soft tissue rolls or excessive tissue  Of good distal soft tissue coverage  Of good load acceptance (surface pressure tolerance) Good stump condition
Good stump Cont….  Of good blood circulation  Free of ROM-limitations (no contractures)  Free of neuroma  Free of bone spurs  Free of phantom pain  Well capable of sensory feedback  Well under amputee’s conscious control
Loss of a limb produces a permanent disability that can impact a patient's self- image, self-care, and mobility (movement). Rehabilitation of the patient with an amputation begins after surgery during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun. Rehabilitation after amputation
The success of rehabilitation depends on many variables, including the following:  level and type of amputation  type and degree of any resulting impairments and disabilities  overall health of the patient  family support
The goal of rehabilitation after an amputation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.
In order to help reach these goals, amputation rehabilitation programs may include the following: treatments to help improve wound healing and stump care activities to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independence exercises that promote muscle strength, and control
 pain management for both post-operative and phantom pain (a sensation of pain that occurs below the level of the amputation)  emotional support to help during the grieving period and with readjustment to a new body image  fitting and use of artificial limbs (prostheses  use of assistive devices  nutritional counseling to promote healing and health  vocational counseling  adapting the home environment for ease of function, safety, accessibility, and mobility  patient and family education
Rehabilitation programs for patients with amputations can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the amputation rehabilitation team, including any/all of the following: The Rehabilitation Team
 Orthopaedists/orthopaedic surgeons  Physical therapist  Occupational therapist  Orthotist  Prosthetist  Social worker  Nurse  vocational counselor The Team
 The major components of a lower extremity prosthesis are:  the socket (with or without a socket liner),  a suspension system,  Joint components (as needed)  a shank (pylon) and  a prosthetic foot LOWER EXTREMITY PROSTHESIS COMPONENTS
 Functions:  The socket serves as the interface between the residual limb and the prosthesis.  protect the residual limb  appropriately transmit the forces associated with standing and ambulation. · The socket
 The PTB with hard socket  Adavantages  Perspiration  Lessy bulky  Easy to clean  Contours won’t compress  Relief's precisely located Socket types
Disadvantages of hard socket  Requires more skill  Not for bony or sensitive residuum  Not easy to modify
Consideration for PTB with Consideration for PTB with soft liner soft liner o Peripheral Vascular Diseases o Thin skin without cushioning o Scarred or sensitive skin o Bilateral patient o Active patient o Peripheral Neuropathy o Less hygienic
 Advantages of frame type contsruction  Deceased weight  Increased comfort  Greater Heat dissipation  Easy to modify
 PTB with cuff suspension  Advantages  Adjustable  Acts as Hyperextension stop  Used with waist belt  Easy to replace
 Disadvantages of PTB with cuff  Inherent pistoning  Restrictive sitting  No added M-L Stability  Un cosmetic  May abrade the skin  Restrict circulation
PTB-SC,SP  Advantages  Increased weight bearing  Rigid hyperextension stop  Increased M-L stability  Improved cosmesis
PTB-SC  Advantages  Less restrictive than PTB-SC,SP  Comfortable kneeling  Difficulty for obese or muscular thighs  Little straps  Some increased M-L stability
PTB with removable brim Large difference between M-L of thigh and knee Supracondylar with hard socket Easier to don Increased bulk
PTB with thigh corset  Increased weight bearing  Improved M-L stability  Unload residuum  Maximum M-L stability  Heavy and bulky  More difficulty to make
Prosthetic Knees The prosthetic knee can have a single axis with a simple hinge and a single pivot point, or it may have a polycentric axis with multiple centers of rotation
Amputation of the lower limb .
Amputation of the lower limb .
Amputation of the lower limb .
Amputation of the lower limb .
Amputation of the lower limb .