AMPUTATION

DEFINITION

Amputation is defined as the surgical removal of a part or whole limb disarticulation means removal of limb through the joint

INDICATION

·    Dead

·    Dying

·    Dangerous

·    Dud

·    Distressing

CONDITION

Traumatic condition

·    Road traffic accidents

·    Occupational crush injuries

·    Train traffic accident

Vascular condition

·     Arteriosclerosis

·     Gangrene

·     Thromboangitiisobliterans

Neoplastic condition

·     Malignant tumours of bone and soft tissues

Infective condition

·     Leprosy

·     Actinomycosis

·     Filarial elephantiasis

·     Gas gangrene

Congenital Condition

·    If the limb is grossly deformed

·    Useless as in pseudoarthrosis tibia

CAUSES

            Common causes of amputation in different age group are as follows

·     Children (congenital anomalies)

·     Young adult(crush injuries)

·     Elderly(vascular condition e.g diabetes)

TYPE OF AMPUTATION

Guillotine amputation

·     This is an emergency amputation done as a life saving measures

·     This is done in cases of gross crush injuries of the limb

·     It is also indicated in case of gas gangrene , when a rapid removal of the dangerously infected part is a life saving procedure

Classical amputation

·     These are planned amputation where regular skin flaps are raised and the wound is closed after ablation of the limb

Revision amputation

·     Revision amputation are done

·     As a second stage in guillotine amputation

·     In those with very unsatisfactory stumps following a previous amputation

LEVEL OF AMPUTATION

UPPER LIMB

  ·        Forequarter amputation

  ·     Shoulder disarticulation

         ·     Above elbow amputation

         ·     Elbow disarticulation

         ·     Below elbow amputation

         ·     Wrist disarticulation

 

LOWER LIMB

·     Hindquarter amputation

·     Hip disarticulation

·     Above knee amputation – ideal cut of at least 12 cm above the joint line

·     Knee joint disarticulation

·     Below knee amputation

·     Ankle & Foot amputation

§ Syme amputation

§ Hindfoot amputation

§ Lisfranc amputation

§ Chopart amputation

PRINCIPLE OF AMPUTATION

·     Remove diseased are damaged part

·     Bones: leaves enough for a good prosthesis and rehabilitation

·     Muscle: should be cut distal to the bone so as to enable 

Myplast- opposing two groups of antagonizing muscles

Myodesis- suturing of

                    Muscles to bone

·     Nerves: should be cut short so that they retract into the muscles tissue

·     Blood vessels: Isolated & ligated doubly

·     Skin flaps : tension free flaps

              Avoid anaesthetic skin on the flaps 

            Delay primary closures if                             

Required

STUMP AND ITS MANAGEMENT

The stump is the residual part of the limb left after the amputation and a surgeon’s work does not finish with amputation

Good stump should

·     Neither be too long nor too short

·     Have a good muscle power with full movement in the proximal joint

·     Have a healthy non adherent scar

·     Splint to prevent a contracture

·     Have a fleshy end with no bony spurs

·     Stump bandaging with crepe bandage to improve its shape for limb fitting

·     Stump exercises to improve its motor power and movement in the proximal joint

·     Stump hygiene to maintain the skin and scar in good condition

COMPLICATION

Immediate

·     Infection

·     Ischaemia

·     Secondary haemorrhage

·     Skin slouging

LATE

·     Painful neuroma

·     Phantom limb

·     Contracture

·     Oedema stump

·     Shrinkage

·     Osteomyelitis of bone

 

PROSTHETIC FITTING

Prosthesis is a replacement or substitution missing or a diseased part.

                      Prosthetic instrument that are used for the limbs

                      Uses of the prosthetic limb are as follows

·     Cosmetic –to provide an improved appearance

·     Functional –to provide function of the missing  part