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Amputation and Limb Prostheses

Amputation and Limb Prostheses. Matthew Lee HMO2. Learning Issues. Background Definitions Anatomy Mechanisms of trauma Assessment of a mangled limb Treatment options and indications for amputation Limb prostheses. Background. Limb amputation is an uncommon and complex problem.

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Amputation and Limb Prostheses

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  1. Amputation and Limb Prostheses Matthew Lee HMO2

  2. Learning Issues • Background • Definitions • Anatomy • Mechanisms of trauma • Assessment of a mangled limb • Treatment options and indications for amputation • Limb prostheses

  3. 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

  4. Definitions • Amputation = removal of a body extremity by surgery or trauma • Prosthesis = artificial extension that replaces a missing body part

  5. Anatomy

  6. Mechanisms of trauma

  7. 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

  8. 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

  9. Treatment options • Primary amputation (within 24 hours of injury) • Early secondary amputation (within 5/7 of injury) • Delayed secondary amputation (after first hospitalisation) • Limb salvage

  10. Limb prostheses • Candidate selection • Prosthesis selection • Common problems

  11. 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

  12. Prosthesis selection • Basic considerations • Comfort • Ease of use • Weight/durability • Mechanics • Cosmetics • Types • Preparatory • Definitive • Function

  13. Common problems • Pressure areas • Contractures • Phantom sensation, phantom pain • Choke syndrome • Dermatological problems

  14. Thank you

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