Amputacja kończyny dolnej to zabieg, który niesie za sobą ryzyko poważnych powikłań. Mogą one dotyczyć nie tylko operowanej kończyny, ale również całego organizmu pacjenta. Z jakimi komplikacjami może się wiązać procedura amputacji, jak można im zapobiegać i w jaki sposób przebiega ich terapia?
Czynniki ryzyka powikłań po amputacji kończyny dolnej
Znaczący wpływ na wystąpienie powikłań po amputacji kończyny dolnej ma stan zdrowia pacjenta. Większym ryzykiem komplikacji objęci są chorzy w zaawansowanym wieku, cierpiący na choroby nowotworowe i schorzenia współistniejące (cukrzyca, choroby układu krążenia i płuc), a także osoby otyłe i stosujące używki.
Duże znaczenie ma również technika przeprowadzenia amputacji, jej rodzaj (poziom amputacji), a także tryb wykonania operacji. Większe ryzyko powikłań wystąpi w przypadku operacji prowadzonych w trybie nagłym, w następstwie ciężkich urazów, a także w przypadku rozległych amputacji.
Kolejny istotny czynnik to odpowiednia rehabilitacja ukierunkowana na odzyskanie przez pacjenta ruchomości biernej i czynnej, a także zapobieganie przykurczom i obrzękom, jak również pielęgnacja i higiena kikuta. W przypadku zaniedbania tych aspektów opieki ryzyko powikłań znacznie wzrasta.
Ostatnia istotna z perspektywy profilaktyki powikłań kwestia to prawidłowe zaprotezowanie pacjenta.
Wczesne powikłania po amputacji kończyny dolnej
Powikłania po amputacji kończyny dolnej można podzielić na wczesne – związane z zabiegiem operacyjnym, oraz późne, do których dochodzi w trakcie procesu rekonwalescencji.
Wśród wczesnych powikłań po amputacji wymienia się zakażenie miejsca operowanego, rozejście rany po amputacji, a także martwicę skóry w okolicy miejsca operowanego. Powikłania te istotnie wpływają na wydłużenie procesu gojenia i rekonwalescencji pacjenta.
Do wczesnych powikłań zalicza się także przykurcze spowodowane zbyt długim ułożeniem kończyny w jednej pozycji lub układaniem jej w pozycji nieprawidłowej, wymuszającej nieregularną pracę mięśni.
Późne powikłania po amputacji kończyny dolnej
Powikłania późne obejmują szerokie spektrum schorzeń i komplikacji, które mogą mieć charakter zarówno miejscowy, jak i ogólnoustrojowy.
Przewlekły obrzęk kikuta może być związany z niedostateczną aktywnością pacjenta lub z nieprawidłowym dobraniem leja protezy (lej nie ma pełnego kontaktu z kikutem lub zwęża się w nieodpowiednim miejscu, powodując ucisk). Długotrwały obrzęk może być związany z innymi dolegliwościami dermatologicznymi, takimi jak zmiany brodawkowate, świąd, grzybice, wyprzenia, zapalenie mieszków włosowych czy wyprysk kontaktowy. Może także dochodzić do nadmiernego rogowacenia skóry, tworzenia modzeli i torbieli. Powikłania skórne mogą dotyczyć nawet 80 proc. pacjentów po amputacjach.
Nieprawidłowa technika operacyjna może doprowadzić do zniekształceń w obrębie kikuta, takich jak zniekształcenie stożkowate, przerost strzałki czy zniekształcenia osi kończyny (np. koślawość kolana).
Poważnym powikłaniem mogącym wystąpić po zabiegu amputacji jest zapalenie kości kikuta oraz tworzenie się martwaków (resztek zniszczonej, oddzielającej się tkanki kostnej).
Inne obserwowane u pacjentów po amputacjach schorzenie to nerwiaki, czyli zlokalizowane w obrębie kikuta bolesne guzy.
Ogólnoustrojowe powikłania po amputacji kończyny dolnej
W wyniku przewlekłego unieruchomienia chorego po amputacji kończyny może dojść do rozwoju powikłań ze strony układu krążenia, takich jak niewydolność krążeniowa, zawał serca, zakrzepica żył głębokich. Możliwe jest także pogorszenie wydolności płuc i zapalenie tego narządu.
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Przeczytaj także: Przyczyny krwawienia do światła przewodu pokarmowego
Proszę o poradę jestem po amputacji nogi 7 miesiecy wczoraj mi spóchł kikut nie moge założyć protezy co mam zrobić
Bardzo proszę o pomoc jestem siódmy miesiąc po amputacji nogi dziś zauważyłem że mam spochniety kikut nie moge założyć protezy proszę o pomoc
Bardzo proszę o poradę jestem 7 miesiecy po amputacji nogi dzisiaj zauważyłem że mam spuchniety kikut nie moge założyć protezy bardzo proszę o odpowiedź
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