AMPUTATION

Juvie Lie F. Ferren, SN

• Amputation is the removal of an extremity by trauma, medical
illness or surgery. As a surgical measure, it is used to control pain
or a disease process in the affected limb, such
as malignancy or gangrene.
• In some cases, it is carried out on individuals as a preventative
surgery for such problems. A special case is that of congenital
amputation, a congenital disorder, where fetal limbs have been
cut off by constrictive bands.
LEVELS OF
AMPUTATION
 UPPER LIMB AMPUTATION

• Wrist Disarticulation - Limb is amputated at the level of

the wrist
• Transradial (below elbow amputations) - Amputation
occurring in the forearm, from the elbow to the wrist
• Transhumeral (above elbow amputations) - Amputation
occurring in the upper arm from the elbow to the shoulder
• Shoulder Disarticulation - Amputation at the level of the
shoulder, with the shoulder blade remaining. The
collarbone may or may not be removed
• Forequarter Amputation - Amputation at the level of the
shoulder in which both the shoulder blade and collar bone
are removed
 LOWER LIMB AMPUTATION

• Foot Amputations - Amputation of any part of the foot.

This includes mid tarsal amputations, Lisfranc
amputation, Boyds amputation & Symes amputation
• Transtibial Amputations (below the knee) - Amputation
occurs at any level from the knee to the ankle
• Knee Disarticulation - Amputation occurs at the level of
the knee joint
• Transfemoral Amputations (above knee ) - Amputation
occurs at any level from the hip to knee joint
• Hip Disarticulation - Amputation is at the hip joint with
the entire thigh and lower portion of the leg being
removed
CAUSES

Circulatory Disorders
• Diabetic vasculopathy
• Sepsis with peripheral necrosis
Neoplasm
• Cancerous bone or soft tissue tumor
Trauma
• Traumatic amputation
• Amputation in utero
Frosbite
COMPLICATIONS

• Edema
• Wounds and infection
• Pain
• Muscle weakness, contractures, and Joint instability
 MANAGEMENT

• A rigid cast dressing, removable

rigid dressing, or an elastic residual
limb shrinker that covers the
residual limb may be used to
provide uniform compression, to
support soft tissues, to control pain
and edema, and to prevent joint
contractures.
NURSING INTERVENTION

• Provide stump care on a routine basis: inspect the area, cleanse and dry
thoroughly, and rewrap stump with an elastic bandage or air splint, or
apply a stump shrinker.
• Assist with specified ROM exercises for both the affected and unaffected
limbs beginning early in the postoperative stage.
• Instruct and assist patient to lie in the prone position as tolerated at
least twice a day with a pillow under the abdomen and lower-extremity
stump.
• Demonstrate the use of mobility aids like trapeze, crutches, or walker.
• Assist with ambulation.
• Inspect dressings and wound; note characteristics of drainage.
• Expose stump to air; wash with mild soap and water after
dressings are discontinued.
• Monitor vital signs.
• Apply antiembolic and sequential compression hose to the non-
operated leg, as indicated.
• Administer low-dose anticoagulant as indicated.
• Assess and consider patient’s preparation for and view of
amputation.
• Encourage expression of fears, negative feelings, and grief over
the loss of body part.
• Reinforce preoperative information including type and location of
amputation, type of prosthetic fitting if appropriate (immediate,
delayed), expected postoperative course, including pain control
and rehabilitation.
• Assess degree of support available to patient.