Lower Extremity

Amputation

Amputations - reasons
congenital limb deficiency - when the limb is grossly deformed and useless
vascular insufficiency (peripheral vascular disease, or PVD) - ischemic
conditions of the limb, such as:
-atherosclerosis and/or arteriosclerosis, predominantly diabetic,
-Buerger's disease (thromboangiitis obliterans) - acute inflammation
and thrombosis (clotting) of arteries and veins in smokers, affecting the
hands and feet; decreased blood flow (ischemia) leads to severe pain, skin
ulcerations and gangrene of the digits (fingers and toes)
malignant tumour of bone or soft tissue, and
traumatic (crush) injury to the limb - due to transport and industrial
accidents.

Amputation, however, should be

attempted only after all forms of
treatment have been exhausted.

Rates of Causes for Amputation

70% of amputations are performed for vascular
disease including diabetic complications,
arteriosclerosis and thromboembolism,
22% due to traumatic injuries and infection
4% result from malignancies
4% due to congenital deformities

Lower Extremity Amputations

Hemipelvectomy: Removal of leg and half of pelvis.

Hip Disarticulation (H/D): Removal of leg at pelvic joint.

Above-Knee (A/K): Removal of leg between hip and knee.

Knee Disarticulation (K/D): Removal of leg at knee.

Below-Knee (B/K): Between knee and ankle.

Syme

Amputation: Removal of foot at ankle (usually performed for injury,

not for vascular problems).

Transmetatarsal/Partial Foot: Removal of part of the foot.

Lower Extremity Amputation Levels

Hemipelvectomy and Hip Disarticulation:
amputation of the entire leg including lateral
portion of pelvis being the ilium, ischium, or pubis
of same side. Usually done in cases of malignant
tumors, extensive gangrene, infection and trauma
Disarticulation: a separation at the joints, hip or
knee

Transfemoral Amputation Levels

Short: large weight-bearing surface if done at level
of lesser trochanter, retains femoral head, and
greater trochanter resulting in an improved
prosthetic fit. Declined due to improved surgical
techniques and assessment of vascular function.

Transfemoral Amputation Levels

Medium: At least 410 cm above lower end of femur to
allow room for prosthetic knee.
Knee disarticulation: Retains thigh muscles giving good
muscular balance, growth potential is maintained,
provides good weight bearing, results in difficulty of swing
phase control in walking, cosmetic asymmetry due to a
prosthetic knee that extends below the other.

Below knee amputation

The ideal level for amputation in the patient
is approximately at the junction of the
proximal/middle thirds of the calf to the
mid-calf.

Transtibial Amputation Levels

Very Short: Usually results from trauma, not an
elective procedure, very small moment arm, retains
knee.
Standard: Elective amputation, provides a well
padded and effective biomechanical lever arm, at
least 8 cm of tibia is required.
Long: Not advised due to poor blood supply in
distal leg.

Too short for use a prosthesis

Transtibial Amputation Levels

Syme: Named for James Syme, a scottish
physician mid 1800s, Ankle disarticulation,
residual limb with good function due to long lever
arm to control prosthesis, ideally suited for weigh
bearing and can last life of patient, can walk
without prosthesis, disadvantages of chronic nerve
damage to posterior tibial nerve.

Transmetatarsal Amputation
Approximately 10,000 performed in US with a
30% failure rate, attributed to the combination of
substantial loss of weight bearing area and reduced
length of lever arm to generate a plantarflexor
movement. Limited to patients with good anterior
tibial pulse and blood flow, usually performed due
to trauma, infection, frostbite, diabetes,
arteriosclerosis localized to the phalanges.

Post Amputation Complications

Contractures
Infections in neglected stumps.
Neuromas--scar tissue full of nerves that can
become sensitive to touch, change of temperature.
Phantom limb or phantom pain--sensation of
presence of old limb in remaining nerve endings;
tends to decrease over time.
Bone spurs.
Low back pain with use of prosthetic.

Traumatic amputation
Severe open fracture that leads to
loss of extremity

Patient with multiple traumatic

injuries poor candidate for
reimplantation

Prosthetics Vs. Orthotics

Prosthesis: An artificial device used to replace a
missing body part, such as a limb, eye, or heart
valve.

Orthosis: An application or apparatus used to

support, align, prevent, or correct deformities or to
improve existing function of movable parts of the
body.