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below knee amputation (BKA)

Etiology: - risk factors - peripheral arterial disease (RR=14) - microvascular disease (RR=4) (diabetes mellitus) - peripheral arterial disease + microvascular disease (RR=23) [2] Epidemiology: - among veterans, incident rate of lower-extremity amputation is 1.2 per 1000 person-years [2] Radiology: - angiography of limited prognostic value - if deep & superficial femoral vessels show occlusion, a BKA will probably not heal Management: post-operative 1) rigid dressing of plaster or fiberglass a) prevents edema b) enhances healing c) protects limb d) prevents knee flexion contraction e) reduces discomfort f) placed in OR g) replace immediately after: 1] wound inspection 2] removal of stitches 3] edema occurs within minutes 2) prosthesis a) 6-10 weeks prior to fitting b) requires less energy than swing-through crutch- assisted walking c) 33% increase in energy consumption with ambulation over baseline - lightweight prosthesis (titanium) recommended for geriatric population

Related

prosthesis

General

limb amputation

References

  1. Genova A. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Beckman JA, Duncan MS, Damrauer SM et al Microvascular Disease, Peripheral Artery Disease and Amputation. Circulation. July 2019 PMID: 31280589 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.040672