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Disarticulation
Transradial
below elbow
disarticulation Transhumeral
above elbow
to use a prosthesis & the less mobility the extremity will have Amputations just above or below a joint are problematic When a surgeon performs the procedure, as much length as is possible is salvaged Muscle tissue is reattached as best as possible but line of muscle pull may be disrupted Skin closure is a problem too. Needs a thick skin pad to protect residual limb.
Diabetes
Frequently results in amputations decreased blood flow to extremity decreased sensation to extremity wound develops which person does not feel wound becomes infected and cannot heal amputation is done as distal as is viable surgeon amputates until viable blood flow is reached frequently extremity will be further amputated as disease progresses
Diabetes Cont.
It is important that we teach pt to self inspect
extremity Early prosthesis of some type is needed so child will use the arm
is still there Pain treated with TENS, desensitization, fluidotherapy, US, nerve blocks or surgery
balance is greatly disturbed body center of gravity is changed balance must be relearned protective reactions must be changed
Stump Management
Shape residual limb so it is tapered at the distal
tourniquet effect pt wears wrap continually check skin 3-4 times each day
Desensitization
percussion weight bearing massage tapping and rubbing
residual limb limb wrapping with ace bandage fluidotherapy rice, beans, etc. vibrator
strength