Limb Loss Background/Etiology

Phase 1: Pre-op

○ Before amputation

○ Goal: prepare physically & emotionally

SLS activities on RLE strength, education on phases of amputation, & maintain UE strength

● Phase 2: Post-op Phase

○ Typically 1-4 weeks post amputation

○ Goal:

heal residual limb & begin early rehab

Phase 3: Pre-prosthetic Training

○ After wound healing, before prosthesis fitting

○ Goal:

prepare for using a prosthesis

Phase 4: Prosthetic Training

○ After prosthetic fitting

○ Goal:

Learn to use prosthesis & return to daily life

how many people live w/ limb loss?

2.1m (507 people per day lose a limb)

what is an important education for limb loss pts?

KEEPING THE SOUND LIMB HEALTHY

how many individuals w/ amputation from vascular disease will die w/in 5 yrs?

nearly 1/2

1 in 6 people w/ amputation will have a “sound side” amputation in future. How many will require a 2nd LE amputation?

55% in 2-3 yrs if pt has diabetes

Diabetes w/ associated Peripheral Vascular Disease accounts for how many LE amputations?

more than 1/2

Post Ambulation Walking Speed:

○ Traumatic amputees walk

faster & burn less energy than dys-vascular amputees

what are s/s of PAD?

venous uclers, leg swelling, skin color & texture changes

Tingling, cramping

◼ Weakness, Pain

◼ foot wounds that heal slowly or not at all

◼ diminished or absent pulse in foot/ankle

◼ Numbness, Shiny skin

◼ leg muscle shrinkage

◼ slow toenail or leg hair growth

◼ a foot or LE that is noticeably cooler, bluer, or paler than rest of body

Individuals w/ DM1 are how many times more likely to require amputation than individuals w/ DM2?

3.5x

Individuals w/ DM2 are how many times more likely to suffer LE amputation compared to healthy individuals?

20x

Individuals w/ DM1 are how many times more likely to suffer LE amputation compared to healthy individuals?

73x

types of LE amputation

Partial Foot

● Transtibial (BKA)

● Knee Disarticulation

● Transfemoral (AKA)

●Hip Disarticulation

●Hemipelvectomy

PARTIAL FOOT - Toe amputation: Partial vs whole toe

Transmetatarsal: Partial metatarsal amputation thru metatarsal bones

● Lisfranc: 

Complete metatarsal amputation, thru tarsometatarsal joint

partial foot - Chopart disarticulation:

partial tarsal amputation thru midtarsal joints

Ankle Disarticulation (Syme):

Complete tarsal amputation

TRANSTIBIAL

● Very short

< 2” below knee joint

○ Less than 20% of tibial length

transtibial - short

2-4 inches below knee joint

transtibial - medium is 5-8” below knee jt, transtibial long is 8” or more below the knee jt when

> 50% of tibial length is preserved

Short transfemoral:

3-4 inches below where?

ischial tuberosity

Less than 35% of femoral length is preserved

surgical technique muscle to muscle

myoplasty

surgical technique muscle attached to periosteum/bone to enhance stability of limb

myodesis

muscle attached to fascia

myofascial

Distal bones can be beveled to decrease areas of pressure to

decrease pain

ERTL Procedure (Bridge between tibia & fibula):

Utilize piece of fibula to create a bridge

Fibula shorter than tibia by approx 1-2 cm

Neuroma prevented by having

nerves cut while on tension & allowed to recoil into muscle

ACUTE WOUND MANAGEMENT

● Interdisciplinary team mgmt in acute care setting

Surgeon/primary MD

○ RN

○ PT/OT

○ pt/family training & education

What is provided in post-op phase of limb loss to protect the incision on the residual limb? for Incision/residual limb protection

AmpuShield Limb Protectors

“Shaping” of limb should begin early in postop healing via

ace wrap

○ Tubular Elastic Compression Stockinette (Tubi Grip)

○ Compression Sock

○ Silicone Sleeves/Gel Liners

WOUND VAC TREATMENT

● Functions & Goals

Promote tissue granulation & wound healing

○ Drain excess fluid

○ Reduce swelling

○ Reduce bacteria in wound

○ Keep wound bed moist & warm

○ Draw together wound edges

○ Increase blood flow to wound

Standard transfemoral is 10-12” below ischial tuberosity when

35-60% of femoral length is preserved

Long transfemoral is Supracondylar

More than how much of femoral length is preserved?

60%