AMPUTATION LOWER EXTREMITY
can be acquired or congenital amputation knee joint, femur intact
congenital amputation- an infant/baby born without Long transfemoral >60% of femoral length
an extremity (above knee)
Medium Transfemoral Between 35% and 60%
Common causes of acquired amputation ( above knee)- conical of femoral length
stump
Peripheral vascular disease (PVD) - most Short transfemoral <35% of femoral length
( above knee)
common cause, associated with DM
Hip disarticulation Amputation through hip
Trauma- usually from MVA, war or gunshots. Often joint; pelvis intact
young adults men Hemipelvectomy Resection of lower half
of the pelvis
Levels of Amputation Hemicorporectomy Amputation both lower
limbs and pelvis below
Partial toe Excision of any part of L4-L5 level. Pelvic
one or more toes organs remain intact
Toe disarticulation Disarticulation at the
metatarsal phalangeal
joint
Partial foot/ray resection Resection of the 3rd and
4th 5th metatarsals and
digits
Transmetatarsal Amputation through the
midsection of all
metatarsals ( can affect Stump- the basal portion of a bodily part (as a limb)
the balance) remaining after the rest is removed. Segment of amputated
Ankle disarticulation Ankle disarticulation with extremity
(syme’s amputation) attachment of heel pad
to distal end of tibia;
may include removal of
malleoli and distal tibial/ Chopart amputation
fibular flares
Long transtibial (below > 50 % of tibial length Midtarsal amputation
knee)
Transtibial ( below knee) Between 20% and 50% Lisfranc amputation
– cylindrical stump of tibial length
Short transtibial ( below <20%of tibial length Tarsometatarsal joint amputation
knee)
Knee disarticulation Amputation through the
AMPUTATION LOWER EXTREMITY
SURGICAL PROCESS Long posterior flaps( skewed flaps) – can include
gastrocnemius ( serve cushion) in BKA , transtibial
Surgery is determined by the surgeon who decision
depends on the status of the extremity at the time of
amputation
Mangled Extremity – secondary to trauma Eg. STABILIZATION OF MAJOR MUSCLES
Firework injuries, MVA
Myofascial closure- muscle is sutured to the deep
Depend upon the VASCULARITY- Eg. PVD
fascia
The surgeon must allow for primary and secondary
Myoplasty- muscle to muscle
wound healing and construct a residual limb for
Myodesis- muscle is attach to periosteum
optimal prosthetic fitting and function
Tenodesis - tendon is attach to periosteum
Skin flaps- healthy skin and tissue that is partly
detached and moved to cover a nearby wound. Must STAGES
with stand WB and pressure from the socket of
prosthesis Immediate post op phase – time between surgery
and discharge from the hospital
FACTORS AFFECTING SELECTION OF LEVELS OF
Pre prosthetic phase – period between discharge
AMPUTATION
from the hospital up to the time that the pt is usually
using his prosthesis
Conservation of residual limb length
Uncomplicated wound healing Immediate postoperative phase
The primary factor for uncomplicated wound healing
is vascularity Main goal – wound healing, reduction of stump,
Postsurgical dressing- main goal is reduction of
Comorbidity stump
o 3 types of dressing- rigid dressing,
the simultaneous presence of two chronic diseases or
semirigid dressing , soft dressing
conditions in a patient.
o Rigid dressing – most effective to control
SKIN FLAPS edema
Equal length anterior and posterior flaps and long 2 types of rigid dressing
posterior flaps
IPOP/ IPORD ( immediate postoperative
Equal length anterior and posterior flaps – mainly for
prosthesis)
ABA , transfemoral amputation
AMPUTATION LOWER EXTREMITY
o hand made from POP, follow general Postsurgical care
configuration of prosthetic socket
o not adjustable/ non removable ( IPORD) Goals-
o the socket must be cut like a cast for removal o healing of the residual limb,
and a new one applied as the residual limb o protect the remaining limb (if dyvascular )
o the pt can perform PWB on the stump o independence in transfer and mobility,
RRD ( removable rigid dressings) o demonstrate proper positioning in bed ,
o Prefabricated plastic material and come in o begin psychological adjustment
different sizes o Understand the process of prosthetic rehab
o Prefabricated RRD are adjustable as the limb
COMPLICATION
changes and may be removed as needed for
wound inspection. o Neuroma
o Dog ears- flaps of skin/ soft tissue. Improper postop
Semirigid dressing
dressing
UNNA’S DRESSING
Early postsurgical evaluation
o Gauze impregnated with a compound of zinc
oxide, gelatine glycerine, and calamine may General system review
be applied in the operating room
Postsurgical status
o more on wound healing
o Cardiovascular
o disadvantage- may loosen easily and not as
o Respiratory
rigid as IPOP
o Diabetes control ( if appropriate)
o shown to be superior to the soft dressing in
o Whether out of bed
enhancing healing and reducing edema
o Infection?
Soft dressing Pain
o Incisional / stump pain
Oldest method of postsurgical management of the Easy to manage with medication.
residual limb and probably the one that most PT in Response well with oral medication
acute care hospital will encounter. o Phantom limb pain
Elastic wrap/ Bandages , elastic shrinkers Missing/ amputated part. Eg.
Osteosarcoma
REHAB PHASE o Other
POSTSURGICAL AND PROSTHETIC REHABILITATION Vascularity
Functional status
AMPUTATION LOWER EXTREMITY
o Bed mobility , transfer, sitting, standing,
balance
Gross ROM
o Unamputated extremity
Hip, knee flexion and extension
Ankle dorsiflexion/ plantarflexion
o UE to note any limitations that would interfere
with functional activities
o Amputated extremity
Phantom limb sensation
- Perception of amputated limb is still present
- All pt will experience this
AMPUTATION LOWER EXTREMITY
