Amputations and Prosthetics

Amputations are classified at the level where the amputation takes place

Types and levels

congenital Acquired lower extremity upper extremity Forequarter Intrascapulothorasic shoulder disarticulation Transhumeral
above elbow

Elbow Disarticulation

Transradial
below elbow

wrist disarticulation Transcarpal Metacarpal phalangeal Transphalangeal partial hand

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.

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

Diabetes Cont.

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

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

Phantom limb sensation/pain

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

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

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

(stump mgmt. cont.)

Elastic shrinker or sock

less effective than ace bandage

Removable rigid dressing plaster or fiberglass replace as residual limb shrinks

Early P/O prosthesis fitted within first 30 days

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

Maintain ROM & strength

Develop independence with ADLs