Amputations

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Introduction[edit | edit source]

Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is that of congenital amputation, a congenital disorder, wherefetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.[1]

Causes of amputations[edit | edit source]

  • Diabetes
  • Chronic leg ulcer leading to Septicaemia
  • Phocomelia (congenital absence of the upper arm or leg)
  • Malignant tumours e.g. sarcoma (cancer of the connective tissue)
  • Arterial insufficiency leading to death or decay of body tissue (gangrene)

Levels of amputations[edit | edit source]

Transfemoral Amputation
  • Through or just above the ankle
  • Below the knee
  • Above the knee
  • Through the foot
  • Through the knee
  • The whole leg or disarticulate leg
  • Removal of the buttock

Signs and symptoms of gangrene[edit | edit source]

  • The tissue is cold and blue (Cyanosis)
  • Pain
  • Intermittent claudication (a cramping pain, induced by exercise and relieved by rest, caused by an inadequate supply of blood to the affected muscles)
  • Clamp-like pain because of a spasm in the arteries of the leg
  • Intense ischaemic pain
  • Increased prevalence in smokers because nicotine causes spasms of blood vessels
  • Most often found in muscles of the leg and calf as a result of atheroma of the arteries
  • Leg pulses are often absent

Location of pulses[edit | edit source]

Femoral Triangle
  • Foot pulse (Medial malleolus or dorsum of the foot)
  • Popliteal (behind the knee)
  • Femoral (within the femoral triangle)
  • If a leg has been amputated because of gangrene, the remaining leg is examined for a pulse

Special investigations[edit | edit source]

Doppler Ultrasound


  • X-rays
  • CT scan
  • Angiogram (outlines blood vessels)
  • Doppler ultrasound (occlusion of vessels)
  • Venogram and arteriogram
  • Radioactive dye injected into the blood

Arterial insufficiency[edit | edit source]

  • Surgery to improve circulation
  • Bypass grafts (autogenous graft uses a vein to bypass the obstructed area)
  • Synthetic grafts

Management[edit | edit source]

Buerger’s exercises[edit | edit source]

[2]
  • Stimulates collateral blood flow in the patient’s leg
  • It is performed for 20 min.
  • The leg is elevated until the toes go white, then lowered, then level
  • Repeat 2-3 times to improve collateral circulation

Connective tissue massage[edit | edit source]

Dynamic stump exercises[edit | edit source]

Balance and gait retraining[edit | edit source]

[3]
[4]
[5]
[6]

Short wave diathermy (SWD)[edit | edit source]

Through the pelvis to warm the arteries (contraindicated in patients with arterial insufficiency because the warmth leads to increased metabolism, causing a greater demand for nutrients, which are not available)

Post-operative care[edit | edit source]

  • Maintain function in the remaining leg and stump to maintain peripheral circulation
  • Maintain respiratory function (important with smokers and those patients under general anaesthesia)

Stump care[edit | edit source]

[7]
  • For hygiene and skin care see handout on amputations
  • A hip flexion Contracture may develop because of elevation to reduce swelling
  • Stump bandaging is done to ‘cone’ the stump, thereby preventing oedema, which occurs because there is no muscle pump and the stump hangs
  • Swelling must be prevented to allow proper attachment of the Prosthesis, and the prevention of Pressure sores
  • The stump sock is put on first, then the prosthesis
  • The prosthesis must be cleaned and maintained (Children who are still growing, grow out of their prostheses)

Types of wheelchairs[edit | edit source]

  • For double lower limb amputations, the wheels are set further back

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ http://en.m.wikipedia.org/wiki/Amputation
  2. ↑ ladybessviernes, UDM PT Students. Buerger Allen's Exercise. Available from: http://www.youtube.com/watch?v=jQUFmOmX35o [last accessed 01/12/12]
  3. ↑ Clegstories. Gait Training with C-Leg®: Stance Phase Training. Available from: http://www.youtube.com/watch?v=Xh4rPJFgRx8 [last accessed 08/12/12]
  4. ↑ Clegstories. Gait Training with C-Leg®: Swing Phase Training. Available from: http://www.youtube.com/watch?v=E11gQs0oIt0 [last accessed 08/12/12]
  5. ↑ Clegstories. Clegstories. Gait Training with C-Leg®: Sitting Down and Standing Up. Available from: http://www.youtube.com/watch?v=_lBkrLZ4PGo [last accessed 08/12/12]
  6. ↑ Clegstories. Gait Training with C-Leg®: Stairs. Available from: http://www.youtube.com/watch?v=Z6bvgDaOkcI [last accessed 08/12/12]
  7. ↑ Richard Major. Physiotherapy Stump or Residual Limb Wrapping. Available from: http://www.youtube.com/watch?v=T1SA_6hzTxQ[last accessed 08/12/12]
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