ABSTRACT
Segmental Doppler limb pressure is a widely accepted non invasive technique in the assessment of peripheral vascular disease. A normal ankle brachial index is 0.9-1. The claudication range is 0.6-0.8. Values less than 0.5 may be associated with rest pain. Doppler readings are unreliable in diabetics due to vessel incompressibility. The six Ps refer to acute arterial insufficiency of any cause. The superficial femoral artery is the most commonly affected vessel, the profunda vessel is usually spared. A trash foot results from showers of emboli (eg from a popliteal aneurysm) that occlude distal vessels, this may occur in the presence of ankle pulses
2 (a) F
(b) T
(c) T
(d) T
(e) F
80% of ischaemic gangrene leads to a below knee amputation. In a long posterior flap, the skin incision should be 15 cm below the tibial tuberosity anteriorly and at the level of the achilles tendon origin posteriorly. The ray amputation is performed in diabetics to treat the collapse of the forefoot arch due to peripheral neuropathy. The complications of amputation are haematoma formation, infection, ischaemic necrosis, osteomyelitis, spurs and osteophytes, ulceration, stump neuroma, phantom limb, causalgia, jactitation, aneurysm, AV fistula, flexion deformity, muscle herniation and non union. The Gritti-Stokes amputation has a longer stump compared to the above knee amputation but it is not possible to fit an internal knee mechanism in the prosthesis.
