Below Knee Amputation: A Look at History, Function & Importance - Essay Sample

Introduction

Below-knee amputation can be defined as a functional option for a selected patient where the lower lime is surgically operated to offer a better quality life than a limb salvage would offer. Below is a discussion of a few things regarding Below the Knee Amputation and an explanation on the way procedure is important

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History of the Procedure

The development of lower limb procedures and amputation surgery has a long history. The procedure was historically stimulated by the aftermath of the Second World War (Miller, Berg, Wilson, Heard, Knepper & Young, 2019). There was very little progress made between the aftermath of the Second World War and the civil war. Considerable progress since then has been made especially by the United States and the research centers within the country. At the end of World War 2, the US government-sponsored research programs that influenced and improved the practice throughout most parts of the world (Miller et al., 2019).

The first application of the below the knee amputee was prepared as a pilot program in the year 1949. The application was also organized as an education and teaching program for the group discipline (Miller et al., 2019). The education was done to organize a teaching clinic team that consisted of a surgeon, prosthetics, physical therapist, occupational therapist and prosthetics representative.

Later in the years when the procedure was launched in Europe, Germany in specific they decided on an arbitrary plan on how the BKA could be used (Miller et al., 2019). It is the medical doctors from the country that decided the functional means on which an optimum amputation level could be used. Since then medical advancement has continued to become increasingly specific on how and when Below Knee Amputation could be used. Most recent publications have made the procedure easily accessible. In the United States of America, the procedure is applicable in more the 80% of medical and surgical centers (Miller et al., 2019).

Indications of the Procedure

Below knee, amputation contains three major indications where each is categorized concerning the most important ones. One of the indications of below the knee amputation is the urgent case. An urgent signal is where the source of an injury of infection outweighs the preservation of the limb that is to be amputated. Urgent indications are surgically performed at the moment when death is imminent. An urgent indication might even necessitate bedside operations especially if there is insufficient time to allow for an operative suite.

Another indication of below the knee amputation is normally of less acute chronic urgency. Such an indication normally initiate surgical procedures performed for non-healing ulcers. Such indications are normally feared to create the risk of impending systemic infection or sepsis. Most of the time the less urgency indication is normally given after operative treatment has failed. The clearest symptom of such an indication is when the limb has limited morbidity which is associated with a systemic bacterial infection.

A relatively urgent indication is when the limb has failed to preserve a mangled lower extremity. It only becomes an indication after possible medical resuscitation and stabilization have not worked as effectively as expected. To take such a decision the medical officer in charge should be informed by vital signs. Some of which might include; soft tissue defects, complete neurovascular compromise, and all these signs should be in extremity.

The final indication of below the knee amputation is non-septic. It is medically conducted on an imminent sick population. Imminent sick populations include those who had multiple infections that keep recurring. The persistent infections lead to below the knee amputation for example; multiple distal to midfoot amputations with persistent infections and vascular infections.

Complications

Just like any surgical procedures below the knee amputation has acute complications. Complications of Below Knee Amputation as medical procedures are categorized into two parts; acute complications and chronic complications. Acute complications of Below Knee Amputation include uncontrolled bleeding. Uncontrolled bleeding might lead to anemia and stress-induced cardiac ischemia. Infection and postoperative pains is another acute complication of BKA. An example of a chronic infection acquired from Below Knee Amputation is distal skin. Distal skin happens when tissue trauma has occurred and the area of surgery increases further infection. Distal skin normally happens when the area of infection was not adequately resected (Schmidt, Abrahamsen, Krarup, & Jakobsen, 2017).

Chronic complications of Below Knee Amputation are those that have deeper health impacts. A painful neuroma is one such example of a chronic complication. Transected nerves during the surgery limit proper intra-operative techniques. When such occurs the patient receives a troubling sensation in the nerves that led to the missing limb. Most below the knee amputees have complained of painful neuroma as a chronic complication. It is a chronic complication since there is not yet a proper technique to heal it. The only option is to use local injection and adjustment to the prosthesis. The final complication of amputation overlooked by medics is the psychiatric and psychosomatic effect that Below Knee Amputation causes the patient. Postoperative patients affected psychologically have ended up depressed and suicidal.

Expected Outcome

Below knee, amputation is only preserved and recommended for patients who have severely damaged the lower limbs. For a disease, there should be no longer any treatment or any surgical method that can rescue the same anymore. Several diseases can warrant the procedure, however, the expected outcome is that the disease does not spread further to the rest of the upper limb. Once the procedure is conducted, it is also expected that the patient has to undergo physical therapy. Physical therapy helps the patient regain a normal body and human activities. Recovery from full surgery is achieved once the patient can use crutches and walkers and other assistive devices without a lot of physical help. The expected results would normally take from four to eight weeks to heal.

Evolutions of the Procedure in Today's Practices

There have been a lot of advances in prosthetic technology. Surgical technology has been advanced to a level it has salvaged lower extremity. Patients in today's practice cannot wear a prosthesis will do better with a poorly functioning leg (Curley, & Chang, 2019). Making decisions like the one mentioned above has been made possible in recent times due to technological evolutions over the years. Lastly, technological evolutions have made it possible to determine which patients can maximally benefit from an amputation.

Conclusion

Below Knee Amputation as a surgical procedure, when conducted after thorough patient selection, leads to optimal operative techniques that allow better-expected outcomes on the part of the patient. The over 3 million studies published regarding the Below Knee Amputation in the past 30 years explain every bit of how the surgical procedure is very important. It is almost true to assume that Below Knee Amputation would soon lead to limb salvage concept.

References

Curley, A. J., & Chang, E. S. (2019). Operative positioning technique for an intertrochanteric fracture in a patient with an ipsilateral below-the-knee amputation: a case report. JBJS case connector, 9(1), e1.

Miller, W., Berg, C., Wilson, M. L., Heard, S., Knepper, B., & Young, H. (2019). Risk Factors for Below-the-Knee Amputation in Diabetic Foot Osteomyelitis after Minor Amputation. Journal of the American Podiatric Medical Association, 109(2), 91-97.

Schmidt, K., Abrahamsen, J., Krarup, N. H., & Jakobsen, T. (2017). Skin perfusion pressure and healing after below-the-knee amputation. Italian Journal of Vascular and Endovascular Surgery, 24(3), 83-88.