Amputation in Surgery
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Transcript of 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