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CONDITION/DISORDER SYNONYM

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  • Below-knee amputation

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ICD-9-CM CODE

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  • V49.75 Below-knee amputation status

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ICD-10-CM CODE

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  • Z89.519 Acquired absence of unspecified leg below knee

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PREFERRED PRACTICE PATTERN

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  • 4J: Impaired Motor Function, Muscle Performance, Range of Motion, Gait, Locomotion, and Balance Associated With Amputation

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PATIENT PRESENTATION

Your patient is a 72-year-old male with a left transtibial amputation. His surgery was done 3 days before. He has an 18-year history of insulin-dependent diabetes mellitus (IDDM). He was diagnosed with Chronic Obstructive Pulmonary Disorder (COPD) 2 years ago. He presents in a semi-recumbent position in the hospital bed with his left limb supported on three pillows. His limb is wrapped, but you can see drainage on the outer layer of the bandage distal to the knee. He is receiving IV antibiotics and pain medication. He is also receiving supplemental oxygen via a nasal cannula.

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KEY FEATURES

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Description
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  • Result of ultimate loss of tissue perfusion from the surrounding circulation at any level distal to the tibial plateau

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Essentials of Diagnosis
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  • A surgeon makes diagnosis after surgery.

  • A transtibial amputation is an amputation of the lower limb between the ankle and the knee where the knee joint is retained.

    • The superior tibiofibular joint is preserved; however, the tibia and the fibula are no longer joined distally.

  • A transtibial amputation is made between the area of the tibial plateau and the junction of the middle and lower third of the tibia.

    • Amputations distal to the lower third of the leg are avoided because of the lack of soft tissue to pad the distal end of the residual limb.

  • An amputation that preserves the femur and the patella is called a knee disarticulation.

  • An amputation at the level of the talocrural joint that leaves the distal end of tibia and fibula intact is called an ankle disarticulation.

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General Considerations1,2
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  • Loss of a limb below the knee results in widespread impairments in body structure and function, as well as significant activity limitations and participation restrictions that will ultimately affect the individual’s participation in family and home life as well as reintegration into society.

  • Emotional support and education must infiltrate postoperative rehabilitation beginning on postoperative day 1 to assist the individual with repossessing life roles.

  • The total recovery period is consistently 12 to 18 months and includes activity recovery, reintegration, prosthetic training, and prosthetic management.

  • The acute hospital stay ranges from 5 to 14 days, and the postacute hospital stay could range from 2 to 8 weeks.

    • This period includes surgery recovery, wound healing, early rehabilitation, and determination of prosthetic readiness.

  • The immediate recovery stage begins with the healing of the wound and could extend up to 6 months.

    • This stage ends with stabilization ...

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