Knee Amputation.pptx

INTRODUCTION
COMPLICATION
PROCEDURE
PROSTHESIS
NURSING CARE

1. Knee Amputation PRESENTED BY Ms. SAKUN RASAILY PAEDIATRIC WARD BPKIHS

2. PRESENTATION O U T LINE RELEVENT ANATOMY OF KNEE. INTRODUCTION OF KNEE AMPUTATION EPIDEMIOLOGY CLASSIFICATION INDICATIONS LEVEL OF AMPUTATION PREVENTION COMPLICATION NURSING DIAGNOSIS NURSING MANAGEMENT PROSTHESIS CONCLUSION REFERENCES POST TEST

3. RELEVENT ANATOMY The Knee Joint is the largest & complex joint in the body . It consists of 3 Joints: Medial Condylar Joint : Between the medial condyle “of the femur” & the medial condyle “of the tibia” . Latral Condylar Joint : Between the lateral condyle “of the femur” & the lateral condyle “of the tibia” . Patellofemoral Joint : Between the patella & the patellar surface of the femur. - The fibula is NOT directly involved in the joint .

4. KNEE ANATOMY IN FIGURE

5. INTRODUCTION Amputation is the surgical removal of a limb or part of a limb by cutting through the shaft of the bone . Through the knee amputations – the removal of the lower leg and knee joint. The remaining stump is still able to bear weight as the whole femur is retained

6. EPIDEMIOLOGY OF DISABILITY  In 2011, the prevalence of persons with disabilities in Nepal was 1.9% of the total population. This figure comes from the question asked in the census, "Do you or any other of your family members have a disability?" The National Population and Housing Census 2011 indicated that physical disabilities represented a third of the total population of persons with disabilities in Nepal.

7. Levels of Amputation Through Knee Amputation 85% Below Knee Amputation 87% Above Knee Amputation 93% Source : Lower Extremity Amputations Around the Knee Joint: A Functional Outcome Study : Nitesh K Karn1,2, MBBS, (FCPS); at all, BBMed , 2019, 3:39-46 LEVEL OF KNEE AMPUTATION

8. TYPES OF KNEE AMPUTATION Below knee amputations-BKA ( transtibial ) – an amputation of the leg below the knee that retains the use of the knee joint . Through the knee amputations – the removal of the lower leg and knee joint. The remaining stump is still able to bear weight as the whole femur is retained Above knee amputation-AKA ( transfemoral ) - an amputation of the leg above the knee joint.

9. I N D IC A TIONS Dead (or Dying) Gangrene Peripheral Vascular disease Atherosclerosis Emb olism S evere Trauma Burns Frost bite Bone setters gangrene Dangerous limb Malignant tumours : Osteosarcoma , Marjolins ulcer Potentially lethal sepsis Crush Injury Damn Nuisance Pain Gross malformation Recurrent Sepsis Severe loss of function Madura foot Elephantiasis Colloquially 3 D’s Dead (or Dying) Dangerous limb Damn Nuisance

10. LEVEL OF AMPUTATION Determined by : a ) Disease process b ) Viability of tissues and c ) Prosthesis available. Determination of adequate blood flow: Clinical : i .) lowest palpable pulse ii.) skin colour and temperature iii.)bleeding at surgery Others: Doppler ultrasonography

11. LEVEL OF AMPUTATION Contd. Transcutaneous oxygen measurement >40mmHg. Skin perfusion pressure measurement by infrared thermography or laser doppler flowmetry. Too short a stump may tend to slip out of prosthesis.Too long a stump may have

12. IDEAL STUMP It Should have Sufficient length to bear prosthesis. Below knee 7.5 - 12.5 cm from tibial tuberosity Above Knee - 23 cm from greater trochanter Conical and Rounded Tenderness Free Adequate joint movement, blood supply. Heal adequately by 1st intention Scar - thin, placed where it is not exposed to pressure, freely mobile over underlying tissues - not interfere with prosthetic function Skin should not be infolded and no redundant soft tissue. Adequate muscle padding - adequate movement

13. EVALUATION OF PATIENT WHO NEED AMPUTATION Check for anemia - correct by blood or packed cells transfusion Infection - control using antibiotic and proper dressing Decision of which limb to be amputated Decision of level of amputation by : Skin temperature Arterial doppler Informed consent should be taken Psychological counselling Plan for prosthesis & rehabilitation by physiotherapist & rehabilitation team.

14. AMPUTATION IN KNEE ABOVE KNEE (AK) AMPUTATION Equal anterior and posterior flaps Ideal femur stump should be 25 cms long. Minimum stump should be 10cms long. It is technically easy, healing chances are better and faster. Cosmetic results poor, prosthesis fitting is not proper, pt limps while walking and need support

15. B E L O W K N E E A M P U TAT I O N ( B U R G E S S ’ ) Min. Stump L e n gt h : 8 C m From Tibial Tuberosity (14-17 C m Is Good) L o n g Posterior F l ap S ca r Anteriorly AMPUTATION IN KNEE

16. PREVENTION Diagnosis and management of diabetes Thorough foot exam once per year Drive safely: Wear your seatbelt Drive the speed limit Safety at work if using heavy equipment, saws, explosives, or flammable substances

17. COMPLICATIONS Early Hemor r ha g e, Hematoma, Infection Gas gangrene Wound dehiscene Gangrene of flaps DVT → Pulm . Embolism Later Pain Infection, bone spur, scar adherent to bone, amputation neuroma Phantom limb Phantom pain Ulceration of the stump pressure effects of the prosthesis/ ↑ ischemia . Early Complications Late Complications

18. NURSING DIAGNOSIS Acute pain r/t surgical amputation Risk for infection r/t a site for organism invasion 2 o to surgical amputation Impaired skin integrity r/t surgical amputation Risk for disturbed sensory perception: phantom limb pain r/t surgical amputation Disturbed body image r/t amputation of a body part Disturbed self-concept r/t loss of a body part Risk for anticipatory grieving r/t loss of a body part Risk for dysfunctional grieving r/t loss of a body part Impaired physical mobility r/t loss of extremity Self-care deficit: feeding, bathing, hygiene, dressing, grooming, or toileting r/t loss of extremity Risk for falls r/t loss of lower extremity Fear r/t surgery, coping with the loss of limb after surgery Ineffective coping r/t failure to accept loss of a body part

19. NURSING MANAGEMENT PREOPERATIVE CARE Assessment and resuscitation Investigate & address co-morbid conditions in consultation with physicians, Anaesthetists & Physiotherapist(multidisciplinary). FBC, FBS, Se/u/c, urinalysis, chest x-ray, ECG, serum albumin(>3.5g/dl). Informed consent –pathology, inevitability of amputation, complications, availability of prosthesis Determine the level of amputation. a)Find a place where healing is mostly to be complete. b)To have an ideal stump for prosthesis fitting.

20. ANAESTHESIA : GA/Spinal POSITION : Supine Psychological support is most important to maintain cardiac hemostasis also. PREINCISION : prophylactic antibiotics, exsanguinate, tourniquet, skin prep & draping. Irrigation with N/S, Removal of tourniquet to meticulously secure haemostasis . Assist in close skin with interrupted non absorbable sutures. Wound dressing- soft or rigid Oxygen saturation vital monitoring assessment. Assess for bleeding and urine output during operation time. If more blood loss infused blood volume. INTRA-OPERATIVE CARE

21. POST OPERATIVE CARE General care : Control of pain, prevention oedema, prevention of infection, DVT prevention, care of concurrent medical conditions., Suture removal. Physiotherapy : Muscles exercised, joints kept mobile, patients taught how to use crutches & prosthesis . NUTRITION : high protein,fiber containing diet,calcium,phosphorous etc . Stump dressing 1. Soft dressing : gauze, cotton wool, bandage, Teach patient or r elative stump bandaging. 2. Rigid dressing : POP cast can be used with stump socks & padding . Cast changed every 5-7 days for skin care.Within 3-4 wks rigid dressing can be changed to a removable temporary prosthesis .

22. PROSTHESIS Is the substitution of a part of the body to achieve optimum function . The term "prosthesis" refers to an external assistive device applied to replace an absent limb.

23. REFERENC E S Surgeryencyclopedia : https ://www.surgeryencyclopedia.com/A-Ce/Amputation.html Text book of Medical Surgical Nursing, 6 th Edition By GN Mandal , Makalu Publication, American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, Illinois 60018-4262. Phone ( 847 ) 823-7186.  http://www.aaos.org  . Amputation; Stump. (2009). Mosby’s dictionary of medicine, nursing, and health professions (8 th ed.). St. Louis, MO: Mosby Elsevier. Read more:  https:// www.surgeryencyclopedia.com/A- Ce /Amputation.html#ixzz6QDgKeLZu Medscape: https ://emedicine.medscape.com/article/1232102-overview#a13 Bailey & Love's Short Practice of Surgery, 27th Edition : International Student's Edition. Pg 1144 . Manipal Manual of Surgery 4 th Edition; K Rajgopal, Anitha Shenoy. Pg 700-704 www.google.com www.slideshare.com www.slidesgo.com

24. POST TEST {1} Types of amputation includes….. a. Below knee amputation b above knee amputation c. Both of above d. None of above {2 } Indications of amputation belongs to a. 3D b.4D c. 5D d. 6D {3 } Complication of amputation………… a. Hemorrhage b. Hematoma c. Pain d. all {4} Amputation means……….