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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