Amputation in Surgery

Dr. Muhammad shahiduzzamanProfessor and Head

Orthopaedics and TraumatologyDhaka Medical College hospital

Amputation

• Derived from the Latin amputare. • "to cut away", from ambi- ("about", "around") and putare ("to

prune").

• Amputation is the complete removal of an injured or deformed body part.

• The English word "amputation" was first applied to surgery in the 17th century.

Amputation

Nomenclature.

History

• Most ancient of surgical procedure.

• Historically were stimulated by the aftermath of war.

• It was a crude procedure by which limb was rapidly severed from unanesthetized patient.

• The open stamp was then crushed or dipped in boiling oil to obtain hemostasis.

• Hippocrates was the first to use ligature.

• Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis.

Amputation

Condition leading to amputation

Trauma

Burns

Peripheral Vascular Disease

Malignant Tumors

Neurologic Conditions

Infections

Congenital Deformities

Amputation

‘DDD’•Dead•Deadly•Dam Nuisance

Amputation

Indications:

Amputation

Trauma

Amputation

Malignant Tumor

Amputation

Gangrene

Crush

Amputation

Amputation

Peripheral Vascular Disease

Polydactyly

Congenial Anomaly

Amputation

Amputation

Scleroderma

Determination of level

Amputation

• Zone of Injury (trauma)• Adequate margins (tumor)• Adequate circulation (vascular disease)• Soft tissue envelope• Bone and joint condition• Control of infection• Nutritional status

Level of Amputation

• Debridement of all Nonviable tissue and foreign material

• Several debridements may be required

• Primary wound closure often contraindicated

• High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viable

Techniques

Amputation

• Nerve• Prevent neuroma formation• Draw nerve distally, section it, allow it to retract

proximally

• Skin• Opportunistic flaps• Rotation flaps• Tension free• Skin grafts

Techniques

Amputation

• Bone:

• Choose appropriate level• Smooth edges of bone• Narrow metaphyseal flare for some disarticulations

• Postoperative Dressing:• Soft• Rigid

Amputation

Techniques

• Goals of Postoperative Management

• Prompt, uncomplicated wound healing• Control of edema• Control of Postoperative pain• Prevention of joint contractures• Rapid rehabilitation

Techniques

Amputation

Below Knee Amputation

• A tourniquet, Unless there is a arterial insufficiency.

• Skin Flaps: Combined length must be 1.5X width.

• Muscles are divided distal to the proposed site of bone section.

• Myodesis: opposing groups are sutured over the bone end to each other and with the periosteum.

• Osteomyodesis: Anchoring opposing muscles group with the bone trough drill hole and sutures.

Principles of techniques

• Nerve are divided proximal to the bone cut to ensure nerve end do not bear weight.

• Tibia is swan across the proposed level and front of the tibia is usually beveled and filed to create a smooth rounded contour.

• Fibula is cut 3 cm shorter. • The main vessels are tied.• The tourniquet is removed and every

bleeding point meticulously ligated.• The skin is sutured carefully without tension.• Suction drain is advised.• Soft figure of eight bandage is given.

Principles of techniques…

BK Amputations:Post operative follow up after 14 days

Amputation

Techniques… Few examples

Amputation

Techniques… Few examples

Amputation

After 12 months

Techniques… Few examples

Amputation

Amputation

Rehabilitation and Prosthetics

Rehabilitations.

Amputation

• 1. Residual Limb Shrinkage and Shaping• 2. Limb Desensitization• 3. Maintain joint range of motion• 4. Strengthen residual limb• 5. Maximize Self reliance• 6. Patient education: Future goals and prosthetic options

Psychological stress.

Amputation

• Up to 2/3 of amputees will manifest postoperative psychiatric symptoms

• Depression• Anxiety• Crying spells• Insomnia• Loss of appetite• Suicidal ideation

Prosthetics

Amputation

PassiveCosmetic

Body PoweredHarnesses and cables

MyoelectricSurface EMGActivation delay

NeuroprostheticsInvestigational

Management of Amputee

Amputation

• Preparation• Good Surgical Technique• Rehabilitation• Early Prosthetic Fitting• Team Approach• Vocational and Activity Rehabilitation

Thank You