Editing Lower extremity amputation

First performed therapeutically by Hippocrates?

Think of it as another therapeutic option in a patient with critical limb ischaemia, which can improve and QoL through pain relief, and return functionality

== Indications ==

* Preservation of life through prevention of ascending infection and tissue loss
* Relief of ischaemic pain
* Removal of a neurologically malfunctioning foot


== Types ==

* Minor
** Digit
*** For minor tissue loss - confined to distal phalanx
*** Tolerated well, apart from great toe
*** Loss of third digit is barely even missed
** Ray
*** Removal of entire phalanx
*** Indications - involvement of proximal phalanx/web space/metatarsal head
** Transmetatarsal
*** Infectious process extends into forefoot
*** Multiple toes are involved
** Chopart
*** Midtarsal joint amputation - calcaneocuboidtalonavicular level (preserves calcaneus and talus)
** Syme
*** Used in severe foot trauma
*** Contraindicated in patients with neurotrophic ulcers or ischaemic vascular disease
*** Can ambulate without a prosthesis
* Major
** Transtibial/BKA
*** 30-60% increase in energy required to ambulate with a prosthetic
*** 75% chance of ambulating with a prosthetic
** Through-knee
*** Rarely performed
*** Sometimes done emergently for ascending infection, then converted to transfemoral amputations once the infection has cleared
** Transfemoral/AKA
*** Can't have BKA because of tissue loss/muscle ischaemia/poor rehab potential
*** 60-100% increase in energy required to ambulate
*** 40% chance of ambulating with a prosthetic
** Hip disarticulation
*** Proximal thigh ischaemia/trauma

== Choice of amputation ==

* Energy expenditure
* Likelihood of healing - of course more likely to hear as you move more proximally
** Palpable pulse proximal to site to level of amputation is a reliable indicator that it will heal
* Check soft tissue integrity, joint mobility, muscle strength
* There are a few other special tests like scintigraphy that MAY be of assistance in predicting which amputations will heal

== Complications ==

* DVT
** Chemoprophylaxis within 24-48 hours
* Wound infection
* Trauma secondary to falls
** Rigid dressings such as plaster or KIWI may help prevent damage to wound
* Contractures - need to start rehab early
* Pain
** Residual stump pain
** Phantom limb pain
*** Cause unknown
*** 25% get it
*** Try pharmacotherapy, nerve stimulation, behavioural therapy
* Contralateral amputation
** Overall 12.5% chance of major contralateral amputation within 5 years

[[Category:Vascular]]