مشاكل البتر- Problems with Amputation - البروفيسور فريح ابوحسان -...

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.


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5-Education of prosthesis care.

6-Home exercise program continued.

7- Follow- up care by rehab. Medicine and prosthetist


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685 amputees

Knight and Urquhart (1989) study


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- 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


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- 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.


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Functional disability associated with U.Limb amputation at all levels are not as great as might be expected.


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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.


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Amputation on the dominant side is more limiting.

Bilateral amputations

multiply problems.


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Long BKA 10%

Medium BKA 25%

Short BKA 40%

Average AKA 65%

Hip disarticulation 100%


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90% BKA will use prosthesis

25% AKA will use prosthesis

75% of bilat BKA will ambulate

< 25% of BK/AK will ambulate


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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


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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.


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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


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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%


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Prevented by

rigid dressing or knee immobilizer

If stump opens up needs re amp.


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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


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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


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A- Contracture , instability

1-Passive stretching of the joint,

2-Exercise to strengthen the muscles

controlling the joint.

1-


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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.


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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-


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=Pain originating in the amp. portion of the limb

=aching, burning, stabbing, or electrical sensations.

=Occurs in 90% of amputee

3-


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=> In young

=> After trauma

=?? Personality disorders

= Usually, decreases during the first 6-12 m after the amp.


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=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.


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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.


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The perception that the amp. limb is still present, but does not cause pain.

4-


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1-Regional nerve block

2-Sympathectomy

3-Neuroma excision

4-Dorsal root rhizotomy

5-Epidural spinal cord stimulation

6-Thalamic stimulation

Phantom limb


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=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-


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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


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Usually mechanical irritation is caused by an ill-fitting socket.

• Fitting problemsas stump size changes with the time

6-


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DVT5-40% (contralateral leg)

=3-7 days P.Op.

=Prophylaxis is important.

7-


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=Redundancy - unstable muscle cushion.

=Bulbous stump

Due to excessive residual soft tissue

May need revision.

8-


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= 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-


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-Poor vascular supply Cold blue stump with pain & ulceration

10-


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Eczema,

Ulceration require revision

at higher level

Blisters

Atrophy

Callosities

Allergic reactions to materials.

11-


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* Sitting asymmetry

* Bulbous stump

e.g Symes in females

* Severely scarred stump

12-


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مشاكل البتر- Problems with Amputation - البروفيسور فريح ابوحسان -...

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Transcript of مشاكل البتر- Problems with Amputation - البروفيسور فريح ابوحسان -...