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limb amputation
Indications:
1) peripheral arterial disease (70%)
- *due to diabetes mellitus (lower extremities)
2) trauma
3) necrosis
4) sarcoma
Epidemiology:
- most patients age 60-75 years
Clinical manifestations:
1) palpable pulses are positive indicators of healing potential
2) dependent rubor is absolute contraindication to amputation at that level
3) best clinical sign is active bleeding at the surgical wound during incision
Radiology:
1) preoperative non-invasive vascular studies are helpful in determining the level of tissue viability
2) post-operative angiography of limited prognostic value
Management:
1) surgical procedure
- final determination for amputation level is made in the operating room
3) goals:
- preserve as much of limb as possible
- optimize function & healing potential
3) post-operative
- rigid dressing of plaster or fiberglass
- see BKA
- not well tolerated in the elderly with AKA
- at least 6-10 weeks necessary for adequate healing prior to prosthetic fitting
4) prognosis
- 5 year survival of diabetic amputees: 39%
- < 50% 2 year survival after bilateral amputation
Related
prosthesis
Specific
above elbow amputation (AEA)
above knee amputation (AKA)
below elbow amputation (BEA)
below knee amputation (BKA)
hand amputation
General
amputation
References
- Genova A. In: Intensive Course in Geriatric Medicine &
Board Review, Marina Del Ray, CA, Sept 12-15, 2001