What type of positioning is used for a patient who has had a below the knee amputation?
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Top Contributors - Niha Mulla, Cornelia Barth, Laura Ritchie, Admin, Rachael Lowe, Saeed Dokhnan, Adam Vallely Farrell, WikiSysop, Kim Jackson, Lauren Lopez, Tony Lowe and Tarina van der Stockt Definition[edit | edit source]Amputation is defined as surgical removal or loss of body part such as arms or limbs in part or full.[1][2][3] Prevalence[edit | edit source]One million limb amputations are reported globally each year. And as of 2017, 57.7 million people across the globe have been living with traumatic amputation. Approximately 185,000 amputations occur in United States each year according to the amputee coalition. And also, as of April 2021, United states has over 2 million Americans living with amputation, and another 28 million at a risk of surgical amputation due to underlying causes.[3][4][5][6] Data from Stanford Healthcare shows 49% rise in total number of amputations during the time of COVID-19 pandemic, during March 2020 to February 2021.[7][8] Causes of Amputations[edit | edit source]There are several conditions that can lead to amputation.[1] [2][3]
Levels of Amputation[edit | edit source]Upper Limb [9][10]
Lower Limb[9][10]
Pre-Surgical Evaluation[edit | edit source]
Surgery for Amputation[edit | edit source]Anesthesia is the first step to any surgery. During amputation, choice of anesthesia depends on the type of amputation, described above on levels of amputation. Two option of anesthesia for amputation are general anesthesia or epidural anesthesia. While performing amputation, special care is to be taken to make sure the procedure does not hamper the functioning of remaining limb. It is vital to condition, shorten & smoothen the remaining bone, so there is a healthy stump that in future can take the load of a prosthetic limb and reduce complication risk. Muscle is sutured to the bone at the distal residual bone so maximal strength of the remaining limb can be retained. This procedure is known as myodesis. Distal stabilization of the muscles is always recommended, allowing for effective muscle contraction and reduced atrophy. This in turn allows for a greater functional use of the stump and maintains soft tissue coverage of the remnant bone. As the procedure for amputation is completed, the wound us sealed by performing myoplasty: suture to opposite muscle in the residual limb to to each other and to the periosteum or to the distal end of the cut bone for weight bearing purposes; and is covered with a bandage. A drainage tube might be placed to drain all excess fluid. Hence, every possible measure is taken to reduce risk of infection.[1] Ideal Stump[edit | edit source]
Stump care[edit | edit source][11]
Complications of Amputation[edit | edit source]
See here, for more detailed information on post-operative complications following an amputation. Post Surgical Evaluation[edit | edit source]
Post-operative Care[edit | edit source]
Pain in Amputation[edit | edit source]Residual Limb pain and phantom limb pain are the two essential types of pain, post amputation.[9] Residual Limb Pain[edit | edit source]Residual limb pain has three main cause:
Phantom Limb Pain[edit | edit source]Phantom limb pain is defined as "pain that is localized in the region of the removed body part." Cause of Phantom limb pain is not fully understood , but it is distressing and has a significant impact on patients life. Psychological Implications of Amputation[edit | edit source]
Fall Risk Post Amputation[edit | edit source]
Goals of Post-operative Physiotherapy Management[edit | edit source]
Post-operative Physiotherapy Management[edit | edit source]
Pre- Prosthetic Evaluation[edit | edit source]
Please find below links to more detailed pages on the management of amputees
More to do with patients with amputation[edit | edit source]
3. Dynamic Stump Exercises 4. Balance and Gait Retraining
5. Short Wave Diathermy (SWD) 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) Walking Again Post Amputation/ Mobility Aids[edit | edit source]
Prosthetic Training[edit | edit source]Prosthetic training is vital for smooth and energy efficient living, while performing all of daily living activities. Below is step by step guidance to prosthetic training:[10]
References[edit | edit source]
How do you position a patient with below the knee amputation?Do lie on a firm bed or couch. Do not put a pillow under your residual limb. Do not put pillows between your thighs. Do not cross your legs • Do not let your residual limb hang over the edge of the bed or couch.
What is the position after amputation?Patients who have undergone transfemoral amputations should be instructed to lie in the prone position multiple times during the day to stretch the hip musculature. Physical therapy should be initiated for early range-of-motion instructions.
Which is proper position for patient with above knee amputation?Lie on a firm surface. Keep your legs flat on the bed or floor. Do not put a pillow under any part of your limb. If you have lost feeling in your full leg, place a small pillow under your lower leg.
What is a below the knee amputation?What is a below-the-knee amputation? A below-the-knee amputation is surgery to remove your leg below the knee. Your doctor removes the leg and keeps as much healthy skin, blood vessel, and nerve tissue as possible. Having your leg removed is traumatic.
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