desired amputation & prosthetic...

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Desired Amputation &

Prosthetic Rehabilitation

Dr Shadrick G Lungu (FFCSecsa)

Konkola Copper Mines.

3rd June 2015

Livingstone-Zambia



• Content

Definition / Background

Zambian statistics – lower limbs

Objectives

Team work

Education

Surgical Considerations

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• Content

Emergency vs. Planned surgery

Post op care

Rehabilitation

Social

Occupation

Desired Amputation & Prosthetic

Rehabilitation

• Definition – Removal of a part [bone(s)]

– Disarticulation – [removal thru a joint]

– Both will be discussed as “amputation”

– Lower limb amputations

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Rehabilitation

• Background – Most ancient of all surgical procedures

– Common in the old civilization

– Also in modern civilization!

– Evidence is available for prehistoric men

• Congenital deformities

• Trauma related amputations


Rehabilitation

• Zambian Statistics

• March & April 2006

• Male : Female = 2.5 : 1

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Rehabilitation

•Zambian Statistic

• Total screened = 183

• Total Amputees = 145 (79%)


Rehabilitation

• Zambian Statistics

• Aetiology

• 1. MVA / RTA

• 2. Congenital abnormalities

• 3. Diabetes & Diabetes related

• ~ 50%

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• Listen to the story

• Examination

• Investigation

• Diagnosis

• Mx Plan



•Objectives

• Remove unhealthy tissue

• Create a less painful leg

• More useful (improve quality of life)

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• Surgical Considerations

• Teamwork



•Education /Counsel

• Phantom Phenomenon!

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Surgeon Physician/Theatre team

Nursing care/Social/

Physiotherapy / Prosthetist / Occupational

Health

Group therapy/Appliances/Others

Patient



• Surgical Considerations • Patients

– Indication

• Social - congenital

• Surgical

• Medical

• Skill / Tools

• Anaesthesia

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• Desired Level of Amputation

AKA

TKA

BKA




• Indication

• Co-morbidities

– Infection

– Poor skin condition (Scarred)

– Contractures

– Vascular disease

– Malignancy e.t.c

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• Urgency – Emergency Vs planned

• Avoid “one-size-fits-all”

– Length

Not too short

Not too long

• “Custom-made” decision = individual case




• Stump length

• 12 – 17 cm (ideal)

• 9cm (remove fibula & some mm)

• 5cm (function may be compromised)

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• Surgical Skills

– Incision placement

– Dealing with

• Nerves

• Vasculature

• Muscle - Tension

• Skin – Tension (1o closure vs. 2o closure)



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• Intra-op / Post op care

• Drainage

• Pressure dressing

• Functional position

– Cast splintage

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• Post op care

• Nursing and pain care

• Antibiotic therapy

• Physiotherapy (early)

– Stump “shrinkage” care

– Passive and active joint mobilization

– Walking aids



• Post op care - Teamwork

• Ward rounds

– Surgeon

– Nurses

– Physiotherapy

– Occupational therapist

– Prosthetist

– (Teachers (children))

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•Anticipated Complications

• Early

• Late



•Anticipated Complications

• Skin break down

• Infection

• Bone overgrowth

• Prosthetic failure / replacement

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•reintegration

– Social (community)

– Occupation



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desired amputation & prosthetic...

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