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Rehabilitation in AmputeesDr Sue InglisMBBS FAFRM DipEdClinEdMyers Street Medical Group
A limb lost every 3 hours: can Australia reduce amputations in people with diabetes?
Shan M Bergin, Jan B Alford, Bernard P Allard, Joel M Gurr, Emma L Holland, Mark W Horsley, Maarten C Kamp, Peter A Lazzarini, Vanessa L Nube, Ashim K Sinha, Jason T Warnock and Paul R Wraight.
Med J Aust 2012; 197 (4): 197-198.
• 30% Increase in diabetes in the last decade
• 8% of diabetic related deaths are due to foot disease
• Minor amputations were 27 times more likely
• Major amputations 38 times more likely
Indigenous people aged 25–49 years with diabetes
Paul E Norman, Deborah E Schoen, Joel M Gurr and Marlene L KolybabaMJA Volume 192 Number 7 5 April 2010
Diabetic Complications• Wound healing
• Renal dysfunction
• Autonomic neuropathy
• Hypoglycaemia with exercise
Level Choosing Factors• Treat underlying disease
• Consider functional potential
• Preserve length
• Fast healing
• Avoid further surgery
Energy Consumption in AmputeesLevel of amputation(Traumatic)
20-25% (Short-40%)(Long-10%)
41% (Gonzalez-1974)
60-70%
118% (Traugh-1975) 260% (Huang 1979)
Increased energy above normal
• BKA
• BKA + BKA• AKA• AKA + BKA• AKA + AKA
Rigid Dressings• Immediate oedema control
• Possible weight-bearing
• Need appropriate personnel
• Application immediately post-operatively
Range of Motion
• Pain control pre and post op
• Avoid propping on pillows, prolonged sitting in flexion
• Prone lying daily
Phantom Pain
• Anticonvulsants (gabapentin / pregabalin)
• Adjuvants antidepressants, antiarhythmics, SSRI?
topical modalities
• Total contact shrinkers
Early Patient Involvement
• Pre-op counselling if possible
• Realistic goal setting
• Learn to touch, massage and wrap stump
• Managing prosthesis
• Risk factor modification
Falling and Fear of Falling(lower extremity amputees)
• Arch Phys Med Rehabil 2001
Aug;82(8):1031-7, Miler et al
• 52% fell past year
• 49% fear of falling
References1. Australian Institute of Health and Welfare. Diabetes: Australian facts 2008. Canberra: AIHW, 2008. (AIHW Cat. No. CVD 40; Diabetes Series No. 8.) http://www.aihw.gov.au/publication-detail/?id=6442468075 (accessed Mar 2012).
2. Payne CB. Diabetes-related lower-limb amputations in Australia. Med J Aust 2000; 173: 352-354.
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9. Santamaria N, Carville K, Ellis I, Prentice J. The effectiveness of digital imaging and remote expert wound consultation on healing rates in chronic lower leg ulcers in the Kimberley region of Western Australia. Primary Intention 2004; 12: 62-70. http://www.awma.com.au/journal/1202_01.pdf(accessed May 2012).
10. Norman PE, Schoen DE, Gurr JM, Kolybaba ML. High rates of amputation among Indigenous people in Western Australia [letter]. Med J Aust 2010; 192: 421.
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