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Amputations and Prosthetics

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Amputations are classified at the level

where the amputation takes place

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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

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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 muchlength 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.

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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

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Diabetes Cont.

It is important that we teach pt to self

inspect their extremities

Proper diet is important

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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

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Phantom limb sensation/pain

The sensation that the amputated extremity

is still there

Pain treated with TENS, desensitization,

fluidotherapy, US, nerve blocks or surgery

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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

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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

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(stump mgmt. cont.)

Elastic shrinker or sock

less effective than ace bandage

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Removable rigid dressingplaster or fiberglass

replace as residual limb

shrinks

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E l P/O h i

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Early P/O prosthesis

fitted within first 30 days

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Desensitization

percussion

weight bearing

massage

tapping and rubbingresidual limb

limb wrapping with acebandage

fluidotherapy

rice, beans, etc.

vibrator Maintain ROM &

strength

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Develop independence with ADLs