Professional Documents
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• Tumor
• Trauma
• Infeksi kronis
Pemeriksaan
• Causa terbesar Penunjang
amputasi
• plethysmography
• oscilometry
Penyakit • skin temperature
pembuluh darah test Penentuan level
perifer • arteriography amputasi
hemycorporectomy
Hindquarter
Hip disarticulation
Thigh amputation
Knee disarticulation
Below-knee amputation
Syme’s procedure
Distal amputation
Tabel Level amputasi
Excision of any part of one or more toes
Partial toe
Toe disarticulation Disarticulation at the MTP joint
Partial foot/ray resection Resection of a portion of up to three metatarsals and digits
Syme’s 15 %
Traumatic TT (BKA) 25 %
Traumatic TF (AKA) 68 %
Vascular TT (BKA) 40 %
Vascular TF (AKA) 100 %
10
Below knee amputation
Phantom
Kontraktur Neuroma
pain
Phantom
sensation
REHABILITATION TREATMENT OF THE
AMPUTATION PATIENT
Pre-operative management
to prevent edema,
covered from
trauma, decrease of
pain, and accleration
of stump maturity Cleaned the stump
Notice the patient
can be given rigid with warm water, Massage the stump
nutrient status,
dressing from fiber soft soap, and to prevent
hemoglobin, diabetic
glass or a plester of antiseptic. Stump development of scar
and give the adequat
Paris or can use must be dried before tissue
antibiotic
elastic bandage or bandage.
elastic stockinetee
for 24 hours, except
when bath or clean
the wound
CONSIDERATIONS WHEN CHOOSING A
PROSTHESIS
Amputation level
Countour of the residual limb
Expected function of the patient
Vocation of the patien
Avocational interests of the patient
Cosmetic importance of the prosthesis
Financial resources of the patient
PROTESA AMPUTASI BAWAH LUTUT
Komponen dasar :
• Foot ankle
assembly
SACH
Single axis
Multiple axis
• Shank :
Endoskeletal
(dari metal/plastik)
lbh ringan,kosmetis
tp lbh mahal & pe-
rawatan lbh sulit
Eksoskeletal
(dr kayu/bhn rigid)
lbh tahan lama,tp lbh
berat & fixed.
…protesa amputasi bawah lutut
• Socket
…protesa amputasi bawah lutut
• Suspension devices
Luka
Tujuan: sembuh, cegah perlekatan
Metode:
-Dressing: soft, semi rigid, rigid
-Cegah kontaminasi: cuci
-Nutrisi (Eneroth)
-Infeksi: medikamentosa
Kulit
Tujuan: penyembuhan luka, cegah perlekatan, desensitisasi, cegah
komplikasi
Metoda:
- hidroterapi : 20-30 mnt
- friction massage
- tapping: 4 x / hr
- cuci : jaga higienis
- atasi komplikasi: uv, hidroterapi,
heating,hiperbarik
- edukasi
Edema
Tujuan: cegah eksesif edema, menunjang penyembuhan dan
pembentukan (shaping)
Cara:
1. IPOP – rigid dressing :
- ambulasi diri
- protesa definitif cepat
bandaging
- shaping cepat
2. Semi rigid dressing
3. Soft dressing: elastic bandage ,
elastic shrinker
4. Lingkungan: massage, latihan,
stump board, elevasi
massage
Bandaging Technique
Fx: support jaringan lunak stump
Mengontrol edema
Shaping stump utk fitting protesa
-dipakai setiap hari , dilepas jika pakai protesa. Dipakai
selama skitar 1thn
- Dimulai ketika luka sdh sembuh, walaupun jahitan blm
diangkat
elastic stockinet
Rigid dressing
IPOP
Sendi dan Otot
Tujuan: jaga lgs; cegah: kontraktur, atrofi, kelemahan; shaping;
fx protesa
Metoda:
1. Positioning:
-Lurus sejajar yg sehat tanpa bantal
-Hr 1: telentang lurus
-Drain lepas: tengkurap 10 mnt – 30 mnt 3x/hr
-Kursi : stump board, hindari fleksi
2. Latihan
- Latihan lgs segera paska op
- Latihan isometrik otot quadriceps hr 2-3
post drain lepas
- Latihan penguatan bertahap
Latihan stretching
Latihan luas gerak sendi
Latihan penguatan
Pelvic tilt
Partial sit up
Neuroma
Cara:
Tujuan: kontrol nyeri
-Modifikasi socket
-Injeksi lidocain-steroid
-USD
-Desensitisasi: tapping, vibrasi
Phantom Sensation
Tujuan: mencegah jatuh
Cara: protesa pylon
Phantom Pain
Sifat :
-Temporer
-Akibat hilangnya inhibisi
-Dipicu: kontak puntung, fx Cara:
otonomik -Analgesik preoperatif
-Gangguan emosi -Desensitisasi
Tujuan tx: hilangkan nyeri -Protesa dini
-Injeksi lokal trigger point
-TENS
-Akupunktur
-Usd
-Perkusi
-Simpatektomi
-Konseling
Diabetic Foot
AMPUTATIONS IN DIABETES
Common:
• Worldwide – amputation 2 to diabetes q 30 sec.
• U.S.A. – 80,000 amputations/y (2002)
– Higher rates in men, racial/ethnic minorities
Costly:
• $60,000/amputation
• $2 billion/y total costs
Lancet 2005; 366:1719 Diabetes Care 2004; 27:1598 Diabetes Care 2003;
26:495