Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
116 - Lower extremity amputations
Published online by Cambridge University Press: 12 January 2010
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
Summary
Lower extremity amputations are performed for tumors, trauma, peripheral vascular disease, infection, or congenital deformity. The goal of treatment is to return the patient to a functional level allowing pain-free ambulation, which is best achieved through a multi-disciplinary approach involving physician, physical therapist, and prosthetic team. Due to the psychological aspects of care it is important to involve the patient in the decision-making process in order to help the patient understand and concur with the medical staff regarding the importance and necessity of performing the amputation.
The vast majority of amputations are performed for vascular disease and infection resulting from diabetic neuropathy; the most common level is a below knee amputation (BKA). The more proximal the amputation, the greater the metabolic cost of walking. Studies have shown that walking speed is decreased and oxygen consumption is increased with more proximal amputations.
The preoperative consideration of several important factors will directly affect the patient's ability to successfully heal from the amputation. The goal of surgery is to leave enough viable tissue that will heal and allow for fitting with a prosthesis. A serum albumin level below 3.5 g/dl indicates a malnourished patient and an absolute lymphocyte count below 1500/mm3 is a sign of immune deficiency; these values should be corrected prior to any elective amputation case. Some advocate the optimization of serum glucose levels in diabetics, but this is not entirely clear.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 741 - 743Publisher: Cambridge University PressPrint publication year: 2006
References
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