13.  Discuss the advantages and disadvantages of the various levels of amputation.

Answer:
Toe amputations: high rate of non-healing and infection; lead to major amputations in 37% cases; mortality rate of 23%.

Toe transphalangeal/transmetatarsal: no need for a special shoe.

Syme amputation (at ankle): advantages- maintains length of the extremity, preserves heel skin which provides an excellent weight bearing stump. Disadvantages-prosthesis is more difficult to fit and because it is bulky, a BK amputation is preferable in females.

Below the knee amputations: advantages over AKA: can still flex the hip and the knee, even if very short can have a bent knee prosthesis made; patients able to have higher level of function, move more easily in and out of bed, and a reduction in the incidence of phantom limb pain.

Above the knee amputations: associated with the highest healing rate in patients with PVD.  The rate of re-amputation is lower which is important in elderly or debilitated patients.  Disadvantages include high mortality rate and high rate of pulmonary embolus.
 

 NEXT QUESTION