Amputation and Prosthesis

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Amputation and Limb Prostheses
Matthew Lee HMO2
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Learning Issues

1. Background
2. Definitions
3. Anatomy
4. Mechanisms of trauma
5. Assessment of a mangled limb
6. Treatment options and indications for amputation
7. Limb prostheses

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Background

• Limb amputation is an uncommon and complex problem

• 90 of amputations are to the lower limb

• Massive trauma is the second leading cause of
  amputation

• Traumatic amputation affects young adults

• Amputation leads to significantly lower physical
  and social functioning

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Definitions

• Amputation removal of a body extremity by
  surgery or trauma

• Prosthesis artificial extension that replaces a
  missing body part

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Anatomy
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Mechanisms of trauma
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Assessment of the mangled limb

• Mechanism (explosion ? penetrating low energy)

• Patients condition (clinical, laboratory)

• Fracture characteristics
• Gustilo Classification for open tibial

• Soft tissue injury

• Vascular injury

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Indications for amputation

• Lack of published evidence
• RMH trauma guidelines (level IV and consensus)
• Damage control surgery (clinical and laboratory
  parameters)
• Complete disruption of tibial nerve
• Massive crush injury (ischaemia gt6hours)
• Near complete traumatic amputation with
  devascularisation or loss of muscle in all 4
  crural compartments
• Massive contamination
• Associated mangled ipsilateral foot

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Treatment options

1. Primary amputation (within 24 hours of injury)
2. Early secondary amputation (within 5/7 of injury)
3. Delayed secondary amputation (after first
   hospitalisation)
4. Limb salvage

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Limb prostheses

1. Candidate selection
2. Prosthesis selection
3. Common problems

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Candidate selection

• Projected function
• K level (0-3)

• Amputation level and stump contour
• Residual strength
• Prosthesis selection

• General health
• Medical comorbidities
• Cognition
• Vision
• Sensorimotor deficits

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Prosthesis selection

• Basic considerations
• Comfort
• Ease of use
• Weight/durability
• Mechanics
• Cosmetics

• Types
• Preparatory
• Definitive

• Function

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Common problems

• Pressure areas

• Contractures

• Phantom sensation, phantom pain

• Choke syndrome

• Dermatological problems

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Thank you