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    Transtibial Amputation

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    okida192
    This document summarizes techniques for transtibial amputation. It discusses that the knee joint should be preserved to aid rehabilitation. There are three levels for transtibial amputations that must be determined individually. Techniques differ for ischemic versus nonischemic limbs, primarily regarding skin flaps and muscle stabilization. For nonischemic limbs, rehabilitation is generally successful with myoplastic closures. Postoperative care includes rigid dressings, limited weight bearing initially, and transition to a removable prosthesis within 3-4 weeks. For ischemic limbs, techniques aim to preserve connections between skin and muscle, and amputations are at a higher level than for nonischemic limbs.

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    Transtibial Amputation

    Uploaded by

    okida192
    82 views24 pages
    This document summarizes techniques for transtibial amputation. It discusses that the knee joint should be preserved to aid rehabilitation. There are three levels for transtibial amputations that must be determined individually. Techniques differ for ischemic versus nonischemic limbs, primarily regarding skin flaps and muscle stabilization. For nonischemic limbs, rehabilitation is generally successful with myoplastic closures. Postoperative care includes rigid dressings, limited weight bearing initially, and transition to a removable prosthesis within 3-4 weeks. For ischemic limbs, techniques aim to preserve connections between skin and muscle, and amputations are at a higher level than for nonischemic limbs.

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    Transtibial amputation technique

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    This document summarizes techniques for transtibial amputation. It discusses that the knee joint should be preserved to aid rehabilitation. There are three levels for transtibial amputations that must be determined individually. Techniques differ for ischemic versus nonischemic limbs, primarily regarding skin flaps and muscle stabilization. For nonischemic limbs, rehabilitation is generally successful with myoplastic closures. Postoperative care includes rigid dressings, limited weight bearing initially, and transition to a removable prosthesis within 3-4 weeks. For ischemic limbs, techniques aim to preserve connections between skin and muscle, and amputations are at a higher level than for nonischemic limbs.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    82 views24 pages

    Transtibial Amputation

    Uploaded by

    okida192
    This document summarizes techniques for transtibial amputation. It discusses that the knee joint should be preserved to aid rehabilitation. There are three levels for transtibial amputations that must be determined individually. Techniques differ for ischemic versus nonischemic limbs, primarily regarding skin flaps and muscle stabilization. For nonischemic limbs, rehabilitation is generally successful with myoplastic closures. Postoperative care includes rigid dressings, limited weight bearing initially, and transition to a removable prosthesis within 3-4 weeks. For ischemic limbs, techniques aim to preserve connections between skin and muscle, and amputations are at a higher level than for nonischemic limbs.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    Transtibial amputation

    Transtibial amputation has become the most


    common level.
    The importance of preserving the patients
    own knee joint in the successful rehabilitation
    of a patient with a lower extremity
    amputation cannot be overemphasized.
    Transtibial
    amputations
    can be divided
    into three
    levels. The
    appropriate
    level must be
    determined for
    each individual
    patient.
    Although many variations in technique exist,
    all procedures may be divided into those for
    nonischemic limbs and those for ischemic
    limbs.
    These two general techniques vary primarily in
    the construction of skin flaps and in muscle
    stabilization techniques.
    Tension myodesis, transected muscle groups
    are sutured to bone under physiological
    tension.
    Myoplasty, muscle is sutured to soft tissue,
    such as opposing muscle groups or fascia.
    Nonischemic limbs:
    In most instances, myoplastic closures are
    performed, but some authors have advocated
    the use of the firmer stabilization provided by
    myodesis in young, active individuals.
    Ischemic limbs:
    Tension myodesis is contraindicated because it
    may compromise further an already marginal
    blood supply.
    A long posterior myocutaneous flap and a
    short or even absent anterior flap are
    recommended for ischemic limbs because
    anteriorly the blood supply is less abundant
    than elsewhere in the leg.
    Nonischemic limb
    Rehabilitation after transtibial amputations in
    nonischemic limbs generally is quite
    successful, partly because of a younger,
    healthier population with fewer
    comorbidities.
    Nonischemic limb
    A longer residual limb would have a more normal
    gait appearance, but stumps extending to the
    distal third of the leg have been considered
    suboptimal because there is less soft tissue
    available for weight bearing and less room to
    accommodate some energy storage systems.
    The distal third of the leg also has been
    considered relatively avascular and slower to heal
    than more proximal levels.
    Nonischemic limb
    In adults, the ideal bone length for a below-
    knee amputation stump is 12.5 to 17.5 cm,
    depending on body height.
    Rule of thumb: allow 2.5 cm of bone length
    for each 30 cm of body height.
    Usually the most satisfactory level is about 15
    cm distal to the medial tibial articular surface.
    A stump less than 12.5 cm long is less
    efficient.
    Nonischemic limb
    Stumps lacking quadriceps function are not
    useful. In a short stump of 8.8 cm or less it has
    been recommended that the entire fibula
    together with some of the muscle bulk be
    removed so that the stump may fit more
    easily into the prosthetic socket.
    Nonischemic limb
    Postoperative care:
    fairly aggressive, unless the patient is
    immunocompromised, there are skin graft issues,
    or there are concomitant injuries or medical
    conditions that preclude early initiation of
    physical therapy.
    An immediate postoperative rigid dressing helps
    control edema, limits knee flexion contracture,
    and protects the limb from external trauma.
    Nonischemic limb
    Postoperative care:
    fairly aggressive, unless the patient is
    immunocompromised, there are skin graft issues,
    or there are concomitant injuries or medical
    conditions that preclude early initiation of
    physical therapy.
    An immediate postoperative rigid dressing helps
    control edema, limits knee flexion contracture,
    and protects the limb from external trauma.
    A prosthetist can be helpful with such casting.
    The cast is changed every 5 to 7 days for skin
    care.
    Weight bearing is limited initially, with
    bilateral upper extremity support from parallel
    bars, a walker, or crutches.
    Within 3 to 4 weeks, the rigid dressing can be
    changed to a removable temporary prosthesis
    if there are no skin complications.
    Ischemic limb
    All techniques stress the need for preserving
    intact the vascular connections between skin
    and muscle by avoiding dissection along tissue
    planes and by constructing myocutaneous
    flaps.
    amputations performed in ischemic limbs are
    customarily at a higher level (e.g., 10 to 12.5
    cm distal to the joint line) than are
    amputations in nonischemic limbs.
    Ischemic limb
    Traditionally, tourniquets have not been used in the
    amputation of dysvascular limbs to avoid damage to
    more proximal diseased arteries.
    A randomized-controlled trial, however, examining the
    effects of an exsanguination tourniquet in transtibial
    amputation of dysvascular limbs revealed decreased
    blood loss, decreased drop in postoperative
    hemoglobin levels, and a decreased need for blood
    transfusion. Compared with controls, no increase in the
    rates of wound healing, revision, or wound breakdown
    were noted.
    Reference
    Campbell 12th ed.

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