11/7/2014 Professor Freih Abuhassan - University of
Jordan
1
1- Strengthening and endurance program.
2- Continued psychological support.
3- Medical management of wound
healing and stump maturation.
4- Effective pain management.
11/7/2014 2Professor Freih Abuhassan - University of
Jordan
3 weeks after amputation1-Standing for short periods of time.
2-Interim Prosthesis at 5 to 6 W
3-Permanent prosthesis at 3 – 6m
4-Education of residual limb care.
11/7/2014 3Professor Freih Abuhassan - University of
Jordan
5-Education of prosthesis care.
6-Home exercise program continued.
7- Follow- up care by rehab. Medicine and prosthetist
11/7/2014 4Professor Freih Abuhassan - University of
Jordan
685 amputees
Knight and Urquhart (1989) study
11/7/2014 5Professor Freih Abuhassan - University of
Jordan
- 03% did not use a walking aid
- 17% walked with the aid of one stick
- 65% used two sticks
- 49% occasionally used, a wheelchair
- 40% required help using stairs
11/7/2014 6Professor Freih Abuhassan - University of
Jordan
- 30% reported difficulty walking indoors.
- 44% reported difficulties walking outside.
- 62% were able to wear their limbs for the
entire day .
- 38% pain was the primary reason
for not wearing the prosthesis.
11/7/2014 7Professor Freih Abuhassan - University of
Jordan
Functional disability associated with U.Limb amputation at all levels are not as great as might be expected.
11/7/2014 8Professor Freih Abuhassan - University of
Jordan
Usually less than a week of training in new techniques with use of adaptive devices is sufficient to restore
independence in most functions, even without a prosthesis.
11/7/2014 9Professor Freih Abuhassan - University of
Jordan
Amputation on the dominant side is more limiting.
Bilateral amputations
multiply problems.
11/7/2014 10Professor Freih Abuhassan - University of
Jordan
Long BKA 10%
Medium BKA 25%
Short BKA 40%
Average AKA 65%
Hip disarticulation 100%
11/7/2014 11Professor Freih Abuhassan - University of
Jordan
90% BKA will use prosthesis
25% AKA will use prosthesis
75% of bilat BKA will ambulate
< 25% of BK/AK will ambulate
11/7/2014 12Professor Freih Abuhassan - University of
Jordan
This group of individuals exhibit a high incidence of
M.I
CHF
Angina,
TIA attack,
Stroke.11/7/2014 13Professor Freih Abuhassan - University of
Jordan
* A high M.R.
= BK 2-5%
= AK9-15%
= Revision 5-10%
* Polyneuropathy
* Retinopathy
* Nephropathy
11/7/2014 14Professor Freih Abuhassan - University of
Jordan
11/7/2014 15Professor Freih Abuhassan - University of
Jordan
Any hematoma should be aspirated, and firm
compression should be applied to the stump
over the affected area.
(Necrosis )
If severe insufficient circulation at the level
of amp. wedge resection or re-amputation
at a more proximal level is necessary.
11/7/2014 16Professor Freih Abuhassan - University of
Jordan
Incidence :12-28%
Related to indication of amp. (especialy in PVD, D.M), Clostridial infection:
2ry to perineal contamination
Prevention1-Staged amputation, decrease rate
from 22%2%
2-Peri-op. antibiotics (Gm+ &-)
3-Avoid stump hematoma
11/7/2014 17Professor Freih Abuhassan - University of
Jordan
1- Inadequate blood supply
2-Traumatic handling of tissues
3-Stump hematoma
4-Metabolic factors
albumin < 3.5
lymph count <1500/mm
BK= 15-20%, AK= 10-15%
11/7/2014 18Professor Freih Abuhassan - University of
Jordan
Prevented by
rigid dressing or knee immobilizer
If stump opens up needs re amp.
11/7/2014 19Professor Freih Abuhassan - University of
Jordan
Flexion contracture1= Proper positioning the stump
2= Early exercises to strengthen the muscles
and mobilize the joints
3= avoid pillow under the knee
4= rigid dressing
11/7/2014 20Professor Freih Abuhassan - University of
Jordan
Wound pain (N= 4-7 days)
Due to ischemic muscle or muscle necrosis
Phantom sensation ?!:the amputated part is still present. It is disturbing
Phantom pain
11/7/2014 21Professor Freih Abuhassan - University of
Jordan
11/7/2014 22Professor Freih Abuhassan - University of
Jordan
A- Contracture , instability
1-Passive stretching of the joint,
2-Exercise to strengthen the muscles
controlling the joint.
1-
11/7/2014 23Professor Freih Abuhassan - University of
Jordan
B- Stiffness & deformity in proximal joint
e.g. after AKAabduction def. of hip
bec. adductor insertion removed while
abductors not disturbed .
Prevented by myoplasty or myodesis.
11/7/2014 24Professor Freih Abuhassan - University of
Jordan
1-Oedema due to prox.venous constr.
resulting from incorrect fitting
sockets
2-Unstable - too much soft tissue left
3-Failure to perform myodesis
2-
11/7/2014 25Professor Freih Abuhassan - University of
Jordan
=Pain originating in the amp. portion of the limb
=aching, burning, stabbing, or electrical sensations.
=Occurs in 90% of amputee
3-
11/7/2014 26Professor Freih Abuhassan - University of
Jordan
=> In young
=> After trauma
=?? Personality disorders
= Usually, decreases during the first 6-12 m after the amp.
11/7/2014 27Professor Freih Abuhassan - University of
Jordan
=If it last > 1 year, is likely to be permanent.
=The treatment of phantom pain is difficult and usually must contain behavioral and psychological components.
11/7/2014 28Professor Freih Abuhassan - University of
Jordan
1- Analgesics
2-Neuroleptics
3-Anticonvulsants
4-Tricyclic antidepressants
5-Beta –blockers
6-Sodium channel blockers11/7/2014 29Professor Freih Abuhassan - University of
Jordan
1-T.E.N.S.
2-Percussion
3-Vibration
4-Massage
5-Acupuncture
6-Biofeedback
7-Hypnosis.
11/7/2014 30Professor Freih Abuhassan - University of
Jordan
The perception that the amp. limb is still present, but does not cause pain.
4-
11/7/2014 31Professor Freih Abuhassan - University of
Jordan
1-Regional nerve block
2-Sympathectomy
3-Neuroma excision
4-Dorsal root rhizotomy
5-Epidural spinal cord stimulation
6-Thalamic stimulation
Phantom limb
11/7/2014 32Professor Freih Abuhassan - University of
Jordan
=Neuromas occur any time a peripheral N. is cut.
=Axonal sprouts and buds grow at the end of the cut N.
=When these are subjected to mechanical trauma, pain occurs.
5-
11/7/2014 33Professor Freih Abuhassan - University of
Jordan
The pain is usually an electrical sensation that radiates in the peripheral N.
Rxreadjustment of the prosthetic
socket if failed the stump may have to be revised
11/7/2014 34Professor Freih Abuhassan - University of
Jordan
Usually mechanical irritation is caused by an ill-fitting socket.
• Fitting problemsas stump size changes with the time
6-
11/7/2014 35Professor Freih Abuhassan - University of
Jordan
DVT5-40% (contralateral leg)
=3-7 days P.Op.
=Prophylaxis is important.
7-
11/7/2014 36Professor Freih Abuhassan - University of
Jordan
=Redundancy - unstable muscle cushion.
=Bulbous stump
Due to excessive residual soft tissue
May need revision.
8-
11/7/2014 37Professor Freih Abuhassan - University of
Jordan
= Conical stumpesp in children as bone continues to grow
uncomfortable with pain.
= Spur formationdue to periosteal bone formation
Avoid periosteal stripping as it may
cause osteoporosis fracture
= Osteomylitis
9-
11/7/2014 38Professor Freih Abuhassan - University of
Jordan
-Poor vascular supply Cold blue stump with pain & ulceration
10-
11/7/2014 39Professor Freih Abuhassan - University of
Jordan
Eczema,
Ulceration require revision
at higher level
Blisters
Atrophy
Callosities
Allergic reactions to materials.
11-
11/7/2014 40Professor Freih Abuhassan - University of
Jordan
* Sitting asymmetry
* Bulbous stump
e.g Symes in females
* Severely scarred stump
12-
11/7/2014 41Professor Freih Abuhassan - University of
Jordan
11/7/2014 42Professor Freih Abuhassan - University of
Jordan
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