Postoperative Management of Lower Extremity Amputations

Goldberg, Tim

doi:10.1016/j.pmr.2005.10.009

Cited by 15 publications

(7 citation statements)

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“…7). [36]. 흔들의자바닥 형태의 신 발이 제한적으로 사용되고 있으며, 내측열이 남아 있는 경우 기능적 으로 큰 문제가 없기 때문에 의족이 반드시 필요한 것은 아니다 [37].…”

Section: 의지unclassified

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Ahn¹

2022

J Wound Manag Res

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Diabetic foot ulcer is a risk factor for amputation. Infection and ischemia in diabetic foot ulcers are common causes of foot amputation. After minimal amputation of the involved lower extremity, precise and cautious application of orthoses and prostheses is very important to recover function of the foot. In this context, several factors including the patient’s general condition, level of amputation, preoperative ability of gait, contracture of adjacent joints, and wound healing potential must be considered. Most orthoses for diabetic foot amputees are used as an off-loading strategy to relieve pressure from the foot and ankle. Total contact cast is the standard treatment for forefoot off-loading. Footwear and insole design orthoses for off-loading in diabetic foot amputees have a low level of evidence and controversial effectiveness. Removable pressure-relieving ankle foot orthoses can be used as an alternative to total contact casts in selective situations. Metatarsal pads can be used effectively to decrease plantar pressure at a low cost. Prostheses after lower extremity amputation must be used with caution for rehabilitation factors due to sustained wound problems and change of stump size.

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Section: 의지unclassified

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Ahn¹

2022

J Wound Manag Res

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“…This highlights the importance of screening the overall limb health of a person with limb loss. In response to prosthetic shear forces exerted on amputated limbs that can cause the deprivation of oxygenated blood 4 and an inadequate supply of 4 nutrients 5 , volume change 6 , skin breakdown, ulceration 7 , tissue post-chronic wound scar formation 8,9 , and even surgical revision may be warranted. On the other hand, conditions of hypoxic or hyperoxia can alter wound healing responses by targeting various molecular markers and cell types 10 .…”

Section: Introductionmentioning

confidence: 99%

Use of Elevated Vacuum Socket System-Based Below-the-Knee Prosthetic Improves Residual Limb Health as Determined by Non-Invasive Spatial Frequency Domain Imaging of Tissue Oxygenation and Hemoglobin Perfusion

GNYAWALI,

Masry,

Dennune

et al. 2024

Preprint

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Preserving residual limb health in lower-limb amputees is of paramount significance, given its pivotal role in their overall well-being and mobility. This work reports that the elevated vacuum suspension (EVS) system improves blood hemoglobin oxygenation and reduces the potential risk of limb ischemia compared to the standard-of-care (SOC) socket-liner system via a global oxygen mapping modality of spatial frequency domain imaging (SFDI) to assess skin oxygenation and hemoglobin perfusion qualitatively and quantitatively in individuals with lower-limb loss. Conventional methodologies, such as pulse oximetry, are recognized for their inherent limitations in yielding localized tissue oxygenation measurements, thereby failing to offer a comprehensive evaluation. The introduced imaging modality is postulated to provide a more holistic and detailed analysis of the content of tissue chromophores compared to traditional point measurement techniques. The research protocol enlisted six subjects who participated in a protracted 32-week regimen. This encompassed an array of assessments, including evaluations of limb health, socket fit tests, and surveys gauging the impact of socket pressure on the limb skin, both pre-, and post-physical activity. This study also sought to ascertain the efficacy of an experimental prosthesis incorporating EVS technology, contrasting its performance against standard-of-care prostheses. The findings indicate that compared to SoC, the use of the EVS socket system has benefited the effects of residual limb as measured by improved tissue oxygen and better deeper tissue hemoglobin perfusion. Such insightful data holds substantial promise in aiding clinicians to render more informed decisions about managing individuals with limb loss.

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“…Approximately, 13% of persons with a transtibial (TT) amputation and 23% of persons with a transfemoral (TF) amputation develop a flexion contracture 25 [2]. A flexion contracture of hip or knee limits full extension and can be caused by several factors [3][4][5][6], including muscle imbalance [3,4]. For example, the more proximal the level of a transfemoral amputation, the more the hip extensor (gluteus maximus), and hip adductors (adductor longus and adductor magnus) are amputated [4].…”

Section: Introductionmentioning

confidence: 99%

“…The immobilization could induce the adhesion of synovial membrane fold contributing to contractures [7]. Lying supine with a pillow underneath the knee or sidelying with hips and knees flexed can lead to hip and knee flexion contractures [5,6]. These incorrect positions may be maintained due to unawareness of a contracture [8].…”

Section: Introductionmentioning

confidence: 99%

Fitting transtibial and transfemoral prostheses in persons with a severe flexion contracture: problems and solutions – a systematic review

Poonsiri

Dijkstra

Geertzen

2021

Disability and Rehabilitation

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Purpose: In persons with a hip or knee flexion contracture 25 , fitting a prosthesis is said to be difficult. This systematic review aims to assess the evidence for fitting of a prosthesis in persons with a severe contracture (25) after a lower limb amputation. Method: PubMed, Embase, Scopus, CINAHL, and Orthotics & Prosthetics Virtual Library databases were searched from inception to December 2019, using database specific search terms related to amputation, prosthesis, and contracture. Reference lists of included studies were checked for relevant studies. Quality of the included studies was assessed using the critical appraisal checklist for case reports (Joanna Briggs Institute). Results: In total, 13 case studies provided evidence for fitting of a prosthesis in more than 63 persons with a transtibial amputation and three with a transfemoral amputation, all of whom had a hip or knee flexion contracture 25. Some studies found a reduction in contractures after prosthesis use. Conclusions: Several techniques for fitting a prosthesis in case of a flexion contracture 25 were found. Contracture reduction occurred in some cases and was possibly related to prosthesis use. Fitting a transtibial or transfemoral prosthesis in persons with a lower limb amputation with a severe flexion contracture is possible. ä IMPLICATIONS FOR REHABILITATION This study provides information on prosthesis prescriptions and adaptations for persons with a transfemoral and transtibial amputation with a flexion contracture 25. The fitting of bent prostheses is not limited by prosthetic components and techniques. Parallel to the use of bent prostheses, it is also important to treat the contracture.

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Postoperative Management of Lower Extremity Amputations

Cited by 15 publications

References 1 publication

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Use of Elevated Vacuum Socket System-Based Below-the-Knee Prosthetic Improves Residual Limb Health as Determined by Non-Invasive Spatial Frequency Domain Imaging of Tissue Oxygenation and Hemoglobin Perfusion

Fitting transtibial and transfemoral prostheses in persons with a severe flexion contracture: problems and solutions – a systematic review

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