Amputation and Prosthesis by 5i2tCzcD

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									Amputation and Limb
    Prostheses




                Matthew Lee
                HMO2
                 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
                    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
                     Definitions
• Amputation = removal of a body extremity by surgery or
  trauma

• Prosthesis = artificial extension that replaces a missing
  body part
Anatomy
      Mechanisms of trauma
      Miscellaneous, 13%

       Firearm, 2%           MBA, 28%

      Crush, 8%




Pedestrian, 12%




                           MVA, 24%
         Domestic, 13%
Assessment of the mangled limb

• Mechanism (explosion  penetrating low energy)

• Patient’s condition (clinical, laboratory)

• Fracture characteristics
   • Gustilo Classification for open tibial #

• Soft tissue injury

• Vascular injury
       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 >6hours)
   • Near complete traumatic amputation with devascularisation or
     loss of muscle in all 4 crural compartments
   • Massive contamination
   • Associated mangled ipsilateral foot
              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
                Limb prostheses
1. Candidate selection
2. Prosthesis selection
3. Common problems
               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
               Prosthesis selection
• Basic considerations
   •   Comfort
   •   Ease of use
   •   Weight/durability
   •   Mechanics
   •   Cosmetics

• Types
   • Preparatory
   • Definitive

• Function
              Common problems
• Pressure areas

• Contractures

• Phantom sensation, phantom pain

• Choke syndrome

• Dermatological problems
Thank you

								
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