PHT 2704 Final Exam Study Guide
ETIOLOGY of Amputations - ANSWER o PVD
o TRAUMA
o MALIGNANCY
o CONGENITAL DEFICIENCY
o Ethnicity: increased rate of amputations among african-americans with PVD
PVD-Peripheral Vascular Disease - ANSWER - compromised blood flow, accounts for
75% of amputations; Surgical procedures (Bypass) attempt to provide re-vascularization
Levels of Amputations - ANSWER o 53% are transtibial (below Knee) amputees
o 33% are transfemoral (above knee) amputees
o The higher the level of the amputation the more difficult ambulation becomes
Partial Toe
Toe Disarticulation
partial foot/ray resection
transmetatarsal
Ankle Disarticulation (Syme's)
Long Transtibial (Below Knee)
Transtibial (Below Knee)
Short Transtibial (below knee)
Knee Disarticulation
Long transfemoral (above knee)
Transfemoral (above knee)
Short Transfemoral (above knee)
Hip disarticulation
Hemipelvectomy
Hemicorpectomy
,Partial Toe- - ANSWER excision of any part of one or more toes
Toe Disarticulation- - ANSWER Disarticulation at the metatarsal phalangeal joint
partial foot/ray resection- - ANSWER resection of the 3rd, 4th, 5th metatarsals and digits
transmetatarsal- - ANSWER amputations through the midsection of all metatarsals
Ankle Disarticulation (Syme's) - ANSWER • ankle disarticulation with attachment of heel
pad to distal end of tibia; may include removal of malleoli and distal tibial/fibular flares
• Plantar flap used from bottom of foot to create weight bearing residual limb
• will have a leg discrepancy
• heel pad is attached to the distal end of the tibia.
Long Transtibial (Below Knee) - ANSWER more than 50% of tibial length
Transtibial (Below Knee)- - ANSWER between 20% and 50% of tibial length
Short Transtibial (below knee)- - ANSWER less than 20% of tibial length
Knee Disarticulation- - ANSWER • amputation through the knee joint; femur intact
• With younger population the growth plates are taken into consideration
Long transfemoral (above knee) - ANSWER -more than 60% of femoral length
Transfemoral (above knee) - ANSWER - between 35%-60% of femoral length
Short Transfemoral (above knee) - ANSWER - less than 35% of femoral length
Hip disarticulation - ANSWER - amputation through hip joint; pelvis intact
Hemipelvectomy - ANSWER - resection of lower half of the pelvis
hemicorpectomy- - ANSWER amputation both lower limbs and pelvis below L4-L5 level
Different Procedures - ANSWER o Myoplasty-
o Myodesis-
o Myofascial closure-
o Tenodesis-
Myoplasty- - ANSWER muscle to muscle closure
Myodesis - ANSWER muscle attached to bone
Myofascial closure- - ANSWER muscle to fascia
,Tenodesis- - ANSWER tendon attached to bone
Important things Surgeons will look for during procedures - ANSWER o Bone: sharp
ends are smoothed and rounded
o Severed peripheral nerves/ Neuromas
o Blood vessels are tied or cauterized
o Incision is usually closed with sutures; drain may be inserted as needed
o Wound healing may be affected by infection, smoking, DM, cardiac disease
Purposes of Post-Operative Dressings - ANSWER o Protection
o Compression/residual limb shaping
o Pain reduction
o Check MD orders; check with nursing for information about wound/incision
o 3 different types of dressings
1- Rigid Dressing
2- Semi-Rigid Dressing
3- Elastic/Soft Bandages
Rigid Dressing - ANSWER Advantages
-compression decreases edema and pain
Disadvantages
-incision not visible for inspection; stays on for weeks
-early weight bearing may delay healing
Immediate post op fitting
Plaster socket
Can have pylon (metal piece- to mimic leg) and foot attached for early WB
Immediate post op prosthesis (IPOP); this is not adjustable or removable
Removable rigid dressing (RRD)
These are expensive and required early prosthetist intervention
Semi-Rigid Dressing - ANSWER Unna's dressing
, May be called Unna boot
Impregnated/medicated gauze that hardens as it gets dry
Disadvantage
-couple of days without inspecting wounds
Elastic/Soft Bandages - ANSWER Advantage
- inexpensive
-lightweight
Disadvantage
-requires skill for application
-frequent reapplication/falls off
-Not very effective for edema control
Shrinkers - ANSWER Type of Elastic/soft bandage
Advantage
• most effective compression
Disadvantage
• incision must be healed
• Sutures + staples must be removed
• Difficult application
• Must be 100% healed
Phantom sensation - ANSWER o Brain registers an awareness of amputated limb
o Experienced by majority of individuals post amputation
o Pt feels the limb that is no longer there; pt may report tingling, burning, itching,
pressure, numbness
Phantom Pain - ANSWER o Brain registers pain in the amputated limb
o 80% of pts may experience this
o Not the same as the phantom sensation
o Pt may report cramping, squeezing, shooting and/or burning pain
ETIOLOGY of Amputations - ANSWER o PVD
o TRAUMA
o MALIGNANCY
o CONGENITAL DEFICIENCY
o Ethnicity: increased rate of amputations among african-americans with PVD
PVD-Peripheral Vascular Disease - ANSWER - compromised blood flow, accounts for
75% of amputations; Surgical procedures (Bypass) attempt to provide re-vascularization
Levels of Amputations - ANSWER o 53% are transtibial (below Knee) amputees
o 33% are transfemoral (above knee) amputees
o The higher the level of the amputation the more difficult ambulation becomes
Partial Toe
Toe Disarticulation
partial foot/ray resection
transmetatarsal
Ankle Disarticulation (Syme's)
Long Transtibial (Below Knee)
Transtibial (Below Knee)
Short Transtibial (below knee)
Knee Disarticulation
Long transfemoral (above knee)
Transfemoral (above knee)
Short Transfemoral (above knee)
Hip disarticulation
Hemipelvectomy
Hemicorpectomy
,Partial Toe- - ANSWER excision of any part of one or more toes
Toe Disarticulation- - ANSWER Disarticulation at the metatarsal phalangeal joint
partial foot/ray resection- - ANSWER resection of the 3rd, 4th, 5th metatarsals and digits
transmetatarsal- - ANSWER amputations through the midsection of all metatarsals
Ankle Disarticulation (Syme's) - ANSWER • ankle disarticulation with attachment of heel
pad to distal end of tibia; may include removal of malleoli and distal tibial/fibular flares
• Plantar flap used from bottom of foot to create weight bearing residual limb
• will have a leg discrepancy
• heel pad is attached to the distal end of the tibia.
Long Transtibial (Below Knee) - ANSWER more than 50% of tibial length
Transtibial (Below Knee)- - ANSWER between 20% and 50% of tibial length
Short Transtibial (below knee)- - ANSWER less than 20% of tibial length
Knee Disarticulation- - ANSWER • amputation through the knee joint; femur intact
• With younger population the growth plates are taken into consideration
Long transfemoral (above knee) - ANSWER -more than 60% of femoral length
Transfemoral (above knee) - ANSWER - between 35%-60% of femoral length
Short Transfemoral (above knee) - ANSWER - less than 35% of femoral length
Hip disarticulation - ANSWER - amputation through hip joint; pelvis intact
Hemipelvectomy - ANSWER - resection of lower half of the pelvis
hemicorpectomy- - ANSWER amputation both lower limbs and pelvis below L4-L5 level
Different Procedures - ANSWER o Myoplasty-
o Myodesis-
o Myofascial closure-
o Tenodesis-
Myoplasty- - ANSWER muscle to muscle closure
Myodesis - ANSWER muscle attached to bone
Myofascial closure- - ANSWER muscle to fascia
,Tenodesis- - ANSWER tendon attached to bone
Important things Surgeons will look for during procedures - ANSWER o Bone: sharp
ends are smoothed and rounded
o Severed peripheral nerves/ Neuromas
o Blood vessels are tied or cauterized
o Incision is usually closed with sutures; drain may be inserted as needed
o Wound healing may be affected by infection, smoking, DM, cardiac disease
Purposes of Post-Operative Dressings - ANSWER o Protection
o Compression/residual limb shaping
o Pain reduction
o Check MD orders; check with nursing for information about wound/incision
o 3 different types of dressings
1- Rigid Dressing
2- Semi-Rigid Dressing
3- Elastic/Soft Bandages
Rigid Dressing - ANSWER Advantages
-compression decreases edema and pain
Disadvantages
-incision not visible for inspection; stays on for weeks
-early weight bearing may delay healing
Immediate post op fitting
Plaster socket
Can have pylon (metal piece- to mimic leg) and foot attached for early WB
Immediate post op prosthesis (IPOP); this is not adjustable or removable
Removable rigid dressing (RRD)
These are expensive and required early prosthetist intervention
Semi-Rigid Dressing - ANSWER Unna's dressing
, May be called Unna boot
Impregnated/medicated gauze that hardens as it gets dry
Disadvantage
-couple of days without inspecting wounds
Elastic/Soft Bandages - ANSWER Advantage
- inexpensive
-lightweight
Disadvantage
-requires skill for application
-frequent reapplication/falls off
-Not very effective for edema control
Shrinkers - ANSWER Type of Elastic/soft bandage
Advantage
• most effective compression
Disadvantage
• incision must be healed
• Sutures + staples must be removed
• Difficult application
• Must be 100% healed
Phantom sensation - ANSWER o Brain registers an awareness of amputated limb
o Experienced by majority of individuals post amputation
o Pt feels the limb that is no longer there; pt may report tingling, burning, itching,
pressure, numbness
Phantom Pain - ANSWER o Brain registers pain in the amputated limb
o 80% of pts may experience this
o Not the same as the phantom sensation
o Pt may report cramping, squeezing, shooting and/or burning pain
