Amputation

AMPUTATIONS

DEFN-REMOVAL OF THE LIMB THROUGH A PART OF THE BONE.

DERIVED FROM LATIN WORD “AMPUTARE” MEANING ‘CUTTING AROUND’

INCIDENCE:AGE-50-75 YRS SEX-MALES[75%] LIMBS-LOWER LIMB[85%]

• POOR CIRCULATION -POVD, DIABETES• INJURY• TRAUMA FROST BITE,BURNS• INFECTIONS FULMINANT GAS GANGRENE,C/C

OSTEOMYELITIS,INFECTED NON UNIONS,C/C INFECTED TROPHIC ULCER

DEAD,DYING,DEVITALISED TISSUES.

TUMOURS-OSTEOSARCOMA

CONGENITAL ANOMALIES most common indication in children

• CLOSED AMPUTATIONS FLAPS ARE FASHIONED AND ARE CLOSED

PRIMARILY ALONG WITH SURGERY.• OPEN AMPUTATIONS FLAPS ARE NOT CLOSED PRIMARILY LATER REVISED AMPUTATION, REAMPUTATION

OR PLASTIC REPAIR1.GUILLOTINE TECHNIQUE ALL THE TISSUES ARE CUT AT THE SAME

LEVEL.IN SEVERE CRUSH INJURIES AND SEVERE INFECTIONS.

CIRCULAR AMPUTATION WITH FLAPS RETAINED FOR LATER

DELAYED SUTURING. OTHER TYPES REVISION AMPUTATION-for ideal stump REAMPUTATION

NON-END BEARING/SIDE BEARING -Weight is taken up by the joint END BEARING/CONE BEARING -Weight is taken up by the body.

• HIGHER THE LEVEL OF AMPUTATION GREATER IS THE DIFF TO RESTORE ABILITY

• AMPUTATION STUMP SHOULD BE LONG ENOUGH

• IF A JOINT IS ARTHRODESED,SECTION AT JOINT LEVEL OR ABOVE

• POVD-LEVEL SHOULD BE BELOW THE DISTAL MOST ARTERIAL PULSATION

• IN ELDERLY FRAIL-BK AMPUTATION• OTHERWISE KNEE DISARTICULATION

IN CLINICAL PRACTICE COLOUR AND TEMP OF THE SKIN

BEFORE SURGERY APPEARANCE OF FREE CAPILLARY

BLEEDING FROM CUT SURFACES ON OPERATION

• SHOULDER DISARTICULATION• SHORT ABOVE ELBOW• STANDARD ABOVE ELBOW• LOW ABOVE ELBOW• ELBOW DISARTICULATION• SHORT BELOW ELBOW • MEDIUM BELOW ELBOW• LONG BELOW ELBOW• WRIST DISARTICULATION

BELOW KNEE-THRU THE TIBIA-FIBULA SYME’S –THRU THE ANKLE JOINT CHOPART’S-THRU THE MIDTARSAL JOINT LISFRANC’S-THRU THE INTERTARSAL

JOINTS.

• ANAESTHESIA-GA OR SAB• TOURNIQUET CONTRA INDICATED IN ISCHAEMIC LIMB

AND ATHEROSCLEROSIS EXSANGUINATION PRIOR TO TOURNIQUET

APPLICATION-CONTRA INDICATED IN INFECTED LIMBS AND MALIGNANCIES

• SKIN FLAPS-GOOD COVERAGE,MOBILE,ADEQUATE LENGTH

• MUSCLES SECTIONED 5 CM DISTAL TO BONY

SECTION 1.MYODESIS-SUTURING TO BONE (CI-ISCHAEMIC LIMB) 2.MYOPLASTY-OPPOSING MUSCLES ARE

SUTUREDADVANTAGES-• SHAPE OF THE STUMP GOOD

INSULATE CUT NERVE ENDINGS MUSCLES ORIGINATING PROXIMALLY

PROVIDE GOOD LEVERAGE PHANTOM PAIN MAY BE PREVENTED PREVENT RETRACTION &PAINFUL MUSCLE

CONTRACTION

• BLOOD VESSELS DOUBLE LIGATION AND CUT• NERVES PULLED AND CUT SO THAT IT RETRACTS

INTO THE STUMP• BONES PERIOSTEAL STRIPPING MINIMISED• DRAIN 48-72 HRS

DRESSINGS1.RIGID DRESSING-POP CAST DECREASED STUMP EDEMA,EARLY

HEALING,LESS POST OP PAIN,TEMPORARY PROSTHETIC FITTING

2.SOFT DRESSING-SOFT BANDAGES AND ELASTOCREPE BANDAGES

• BEGIN ASAP• GOALS –REDUCE EDEMA, INCREASE

STRENGTH, PREVENT CONTRACTURES, MAXIMISE FUNCTIONAL INDEPENDENCE.

• BALANCE & COORDINATION ACTIVITIES FOR GAIT TRAINING.

• WALKING AIDS• ALSO VOCATIONAL TRAINING, PAIN MNGMT,

PSYCHO EDUCATION.

• HAEMATOMA• INFECTIONS• NECROSIS OF SKIN FLAPS• CONTRACTURES• PAINFUL NEUROMAS• PHANTOM LIMB

• IDEAL LENGTH• IDEAL SHAPE• MUSCULAR• GOOD POWER OF MUSCLES• NO FIXED DEFORMITY• FULL AND FREE MOVTS OF JOINT ABOVE• INFN FREE• NON ADHERENT INCISION SCAR• ABSENCE OF NEUROMA

CAN BE ACHIEVED BY• STUMP DRAINAGE• STUMP SPLINTING• STUMP BANDAGING• STUMP EXERCISES EARLY• STUMP HYGEINE

MC AMPUTATION PERFORMED A LONG POSTERIOR FLAP WITH SCAR

PLACED OVER ANTERIOR ASPECT IS USED. PROSTHESIS PLACEMENT IS BETTER HERE

WITH GREATER RANGE OF MOVTS WITHOUT LIMP AND WITHOUT SUPPORT.

FIBULA SHOULD BE DIVIDED FIRST TIBIAL STUMP SHUD BE BEVELED ANTRLY POSTR MUSCLES ARE SUTURED ACROSS THE

BONE ENDTO THE PERIOSTEUM IN FRONT.

ANKLE DISARTICULATION,REMOVAL OF MALLEOLI AND ANCHORING HEEL PAD TO THE WEIGHT BEARING AREA

TWO POINTS 1.75 CM BELOW LAT MALLEOLUS AND 2.5 CM BELOW MED MALLEOLUS ARE JOINED INFRONT OF THE ANKLE AND ALSO VERTICALLY ACROSS THE HEEL PAD

ANT INCISION DEEPENED-TALUS AND CALCANEUM REMOVED LEAVING ALL SOFT TISSUE IN THE FLAP

MEDIAL AND LATERAL MALLEOLI ALONG WITH A THIN SLICE OF TIBIA REMOVED

ADV-PATIENT CAN WALK WITHOUT A PROSTHESIS

AMPUTATION THROUGH INTER TARSAL JOINTS

SEVERE EQUINUS DEFORMITY FRICTION IN ANTERO POSTERIOR PART OF

THE STUMP.

AMPUTATION THROUGH MID TARSAL JOINT SUBTALAR FUSION AND ELONGATON OF

TENDO ACHILLES

PIGROFF’S AMPUTATION ANT PART OF CALCANEUM IS CUT ACROSS AND RAW BONE IS FIXED TO THE RAW

UNDERSURFACE OF TIBIA CALCANEAL TUBEROSITY -WEIGHT BEARING

AREA

BOYD’S AMPUTATION TALUS IS EXCISED CALCANEUM IS ADVANCED AND ATTACHED

TO THE RAW UNDERSURFACE OF TIBIA STABLE LOAD BEARING SURFACE

THANK YOU