limb amputation

Epidemiology

• most patients age 60-75 years

Indications

• peripheral arterial disease (70%)
  • due to diabetes mellitus (lower extremities)
• trauma
• necrosis
• sarcoma

Clinical manifestations

• palpable pulses are positive indicators of healing potential
• dependent rubor is absolute contraindication to amputation at that level
• best clinical sign is active bleeding at the surgical wound during incision

Radiology

• preoperative non-invasive vascular studies are helpful in determining the level of tissue viability
• post-operative angiography of limited prognostic value

Management

• surgical procedure
  • final determination for amputation level is made in the operating room
• goals:
  • preserve as much of limb as possible
  • optimize function & healing potential
• 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
• prognosis
  • 5 year survival of diabetic amputees: 39%
  • < 50% 2 year survival after bilateral amputation

More general terms

• amputation

More specific terms

• above elbow amputation (AEA)
• above knee amputation (AKA)
• below elbow amputation (BEA)
• below knee amputation (BKA)
• hand amputation

Additional terms

• prosthesis