I. Pathophysiology—Partial or complete detachment of body
part with residual extremity covered with well-vascularized
muscle and skin, although reattachment surgery may be
possible for fingers, hands, and arms
a. Primarily two types of amputations
i. Open or provisional: requires subsequent revisions
ii. Closed or flap: all surgical revision is performed and the
wound closed in one procedure
b. Five levels currently used in lower-extremity amputation:
foot and ankle, below knee (BKA), knee disarticulation and
above (thigh), knee-hip disarticulation, and hemipelvectomy
and translumbar amputation
c. Two basic types of prosthetic designs are used: exoskeletal
a. Varied causes (Ellis, 2007)
i. Peripheral vascular disease, often associated with
diabetes, usually involves lower extremity; most common
in the United States, accounting for 65% of cases
ii. Trauma: battlefield wounds; upper extremity more
iii. Malignant bone tumors
iv. Infections: osteomyelitis, gangrene
v. Congenital disorders: approximately 5% of cases
b. Lower-extremity amputations are performed much more
frequently than upper-extremity amputations.
c. Upper-extremity amputations generally result from trauma
caused by industrial accidents.
a. Morbidity: Approximately 70,000 new major amputations
performed annually in the United States (Ellis, 2007);
use and early implementation of prosthetic devices are
improving long-term outcomes.
b. Mortality: Dependent on underlying pathology; survival
rates decreased in presence of diabetes and end-stage renal
disease as well as with above-the-knee amputations
(Aulivola et al, 2004).
Client is treated in inpatient acute surgical unit and subacute
or rehabilitation unit.
Diabetes mellitus/diabetic ketoacidosis
Psychosocial aspects of care
1. Support psychological and physiological adjustment.
2. Alleviate pain.
3. Prevent complications.
4. Promote mobility and functional abilities.
5. Provide information about surgical procedure, prognosis,
and treatment needs.
1. Dealing with current situation realistically.
2. Pain relieved or controlled.
3. Complications prevented or minimized.
4. Mobility and function regained or compensated for.
5. Surgical procedure, prognosis, and therapeutic regimen
6. Plan in place to meet needs after discharge.