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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Discuss the implications of etiology and incidence of amputation surgery.

  2. Describe the process of amputation surgery in relation to residual limb characteristics and patient function.

  3. Describe the functional results of amputation surgery.

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CASE STUDIES

The following clients have been referred to physical therapy for postsurgical care:

  • Janice Simmons, a 65-year-old woman, had a left transtibial amputation yesterday secondary to diabetic gangrene and a nonhealing ulcer on the plantar surface of the right foot.

  • John Adams, a 72-year-old man, had a right transfemoral amputation yesterday secondary to chronic arteriosclerosis obliterans.

  • Richard Canto, a 19-year-old Army soldier who underwent traumatic transtibial amputation secondary to a road bomb encounter in Iraq 2 days ago; he was evacuated to an Army hospital in Germany where efforts to save the limb failed. He also sustained some shrapnel injuries to his chest and right arm, but these are not considered serious.

  • Linda Bean is a 12-year-old female who underwent a transfemoral amputation yesterday secondary to grade IIB osteogenic sarcoma of the proximal right tibia; the tumor was not appropriate for tumor resection and reconstruction.

Case Study Activities

All Students

  1. For each client, describe what the surgeon will do with the bone, blood vessels, nerves, muscle tissue, and skin during each amputation. Review the surgery depicted at www.ampsurg.org.

Physical Therapy Students

  1. Identify what you need to know about amputation surgery to select appropriate tests and measures and develop a postsurgical plan of care.

Physical Therapist Assistant Students

  1. Identify what you need to know about amputation surgery to implement selected postsurgical interventions.

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EPIDEMIOLOGY AND ETIOLOGY OF AMPUTATIONS

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It is estimated by the Centers for Disease Control and Prevention that there are approximately 1.8 million people living in the United States with the loss of one or more limbs. One out of every 200 people has had one or more amputations. The majority of amputations, approximately 82%, are due to peripheral vascular disease, with more than 50% of these due to complications of diabetes. Among lower extremity amputations, over 90% are due to vascular diseases.1 Other causes of amputation include trauma, tumors, and congenital malformation. Among upper extremity amputations, the leading cause is trauma.

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Dillingham and associates1 studied the rates and trends in amputation from 1988 to 1996 and found a 27% increase in new amputations for vascular disease, while amputations for all other causes showed a decrease. In 2004, the last full year for which data are available, there were 114,548 hospital discharges with a primary diagnosis of amputation.2 Dillingham and associates further indicated that hospital discharges for dysvascular amputations increased about 3% per year for the study period.

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The risk of amputation for dysvascular disease increases with age, sex, and race. Dillingham and associates1 found that amputations among blacks over the age of 85 ...

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