Amputations

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Amputations
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• Amputations are classified at the level where the
  amputation takes place

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Types and levels

• congenital
• Acquired
• lower extremity
• upper extremity
• forequarter
• shoulder disarticulation

• above elbow
• below elbow
• wrist disarticulation
• partial hand

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• The higher the amputation, the more difficult it
  is to use a prosthesis the less mobility the
  extremity will have
• Amputations just above or below a joint are
  problematic
• When a surgeon performs the procedure, as much
  length as is possible is salvaged
• Muscle tissue is reattached as best as possible
  but line of muscle pull may be disrupted
• Skin closure is a problem too. Needs a thick
  skin pad to protect residual limb.

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Diabetes

• Frequently results in amputations
• decreased blood flow to extremity
• decreased sensation to extremity
• wound develops which person does not feel
• wound becomes infected and cannot heal
• amputation is done as distal as is viable
• surgeon amputates until viable blood flow is
  reached
• frequently extremity will be further amputated as
  disease progresses

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Diabetes Cont.

• It is important that we teach pt to self inspect
  their extremities
• Proper diet is important

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Problems associated with congenital amputations

• Child has never learned to function with that
  extremity
• Early prosthesis of some type is needed so child
  will use the arm

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Phantom limb sensation/pain

• The sensation that the amputated extremity is
  still there
• Pain treated with TENS, desensitization,
  fluidotherapy, US, nerve blocks or surgery

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Other complications S/P amputation

• Depression is common
• Falls
• stand on side of LE amputation
• balance is greatly disturbed
• body center of gravity is changed
• balance must be relearned
• protective reactions must be changed

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Stump Management

• Shape residual limb so it is tapered at the
  distal end to allow for prosthetic fit
• Figure 8 ace bandage wrap
• wrapped distal to proximal
• more pressure distally
• never wrap circular direction because of
  tourniquet effect
• pt wears wrap continually
• check skin 3-4 times each day

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(stump mgmt. cont.)

• Elastic shrinker or sock
• less effective than ace bandage
• Removable rigid dressing
• plaster or fiberglass
• replace as residual limb shrinks
• Immediate postop (P/O) prosthesis
• Early P/O prosthesis
• fitted within first 30 days

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• Desensitization
• percussion
• weight bearing
• massage
• tapping and rubbing residual limb
• limb wrapping with ace bandage
• fluidotherapy
• rice, beans, etc.
• Maintain ROM strength

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• Develop independence with ADLs