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Life After Amputation Nicola Storer Graham Bowen Stephen Baxter Learning Outcomes When do you perform an amputation. Factors that determine level of amputation. Functional changes related to the amputation. Advantages of planning


  1. Life After Amputation Nicola Storer Graham Bowen Stephen Baxter

  2. Learning Outcomes • When do you perform an amputation. • Factors that determine level of amputation. • Functional changes related to the amputation. • Advantages of planning an amputation.

  3. What Do We Mean by Amputation? Media Medical

  4. Why are Amputations Performed? Control Pathology Control Patients’ Symptom • Infection • Mechanical • Ischaemia • Neurological • Tumour • Psychological

  5. Classification of Amputation. MINOR - Below Ankle MAJOR - Above Ankle • Phalangeal • Transtibial • Metatarsal • Genicular • Tarsal • Transfemoral • Disarticulation Orthotics Prosthetics

  6. Common Factors • Transecting Nerves • Tissue Dead Space • Predicting Wound Healing • Predicting Bacterial Load

  7. Amputation Pathway Elective Urgent MDT Discussion Not Fit for Fit for Surgery Surgery Medical Optimisation Rehabilitation Physiotherapy/ Palliative Care OT Level of team Social Service Amputation requirements determined by Vascular Supply and Therapy advice

  8. Phalangeal Amputations • Medial • Lateral • 1 st & 5 th – retain proxi head • Best procedure for the future outcome function. • Retain cartilage?

  9. Biomechanical Changes from Losing a Toe. Affecting factors • Impact of neuropathy. • Changes from infection/ surgery.

  10. Metatarsal Amputations • Ray Amputation • Transmetatarsal

  11. Biomechanical Changes from Disrupting the Forefoot. • Decrease power generation across ankle. • Diabetes has greater effect on gait kinematics. • Orthotics have little impact on gait restoration.

  12. Tarsal Amputations • Lisfranc • Chopart Need to be combined with a procedure to reduce power from plantar-flexors.

  13. Biomechanical changes of midfoot Amputations • Unopposed Plantarflexion. • Minimal mobility requirements. • Cognitive impairment.

  14. General Facts about Major Amputations • Using a prosthesis is hard work. • Motivation/ practise. • Significant Impact on QoL.

  15. Transtibial Amputations • Blood supply • Background mobility/ flexibility • Preparation for prosthetic interface

  16. Effects of Trans-tibial Amputation. • Increase effort 40-80% • Higher risk of breakdown • Patella Tendon Bearing

  17. Through-Knee Amputation • End Bearing (Mostly) • Similar Functionality to TFA. • Shorter socket • Cosmetic issues

  18. Considerations when going through the Knee • Skin cover in from below the knee. • The joint surface is cartilaginous. • End bearing surface must have good quality skin.

  19. Transfemoral Amputation • Ischial weight bearing • Decrease adductor/ extensor function. • Increase effort 100-150% • Socket retention/ volume changes.

  20. Impact of losing femoral length. • Femoral (lap) Length • ↓ Hip extension. • Limb Volume • Arterial perfusion Optimusprosthetics.com • Comorbidities Physio-pedia.com

  21. What Does the Future Hold? Impending Health Burden on the NHS

  22. You Only Get Out What You Put In! ACSIS (Amputee and Carers Support in Southampton)

  23. Every Amputation has a Significant Impact. Optimised Healthcare Management can Improve the Patients’ Outcome.

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