Dr. Dr. M. AZHAR QURESHI Consultant General Surgeon KKMC HOSPITAL
DEFINITION •
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Removal of the whole or part of an arm/hand or a leg/foot Amputations can occur after an injury (traumatic amputation) or deliberately at surgery
WHY TO AMPUTATE ??
“A useful and painless artificial limb is better than a painful and non functional natural limb”
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INCIDENCE
trauma 10% vascular/ diabetes 83%
tumors 3%
Other 4%
infections 1%
Neurological/ congenital 3%
INDICATIONS •
Three main groups:
a.
Dead :
Due to arterial occlusive disease causing gangrene
b.
Deadly :
This is seen in moist gangrene when putrefaction and infection spreads to involve adjacent healthy tissues.
c.
Dead Loss: When due to relentless ischemic pain, paralysis, trauma or deformity the limb can not be used or it hinders its normal function
GENERAL PRINCIPLES OF AMPUTATIONS •
Treat the cause if possible and try to save the limb
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Get informed consent
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Discuss the level with experts in regional limb fitting center
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General anesthesia is preferable
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Try to preserve joints
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Try to preserve epiphysis in children
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For tumors confirm the diagnosis with tissue biopsy 7
PREPARATION •
Prophylactic antibiotics
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Clean the limb and seal off infected or necrotic area
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Arrange for disposal of limbs
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Clearly mark the affected limb
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OPERATIVE PROCEDURE 1.
Flaps
2.
Division of skin and muscles
3.
Nerves
4.
Blood vessels
5.
Bone
6.
Closure 9
STUMP LENGTH •
In the upper arm and fore arm a 20 cm stump is recommended
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For lower leg a 14 cm tibial stump is ideal
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A stump a less than 8 cm is difficult to secure in a prosthesis In an above knee amputation a 25 to 30 cm stump is optimum
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UPPER LIMB AMPUTATIONS • • • •
Fingers Hands Arm and Fore arm Krukenberg amputation: The Krukenberg procedure also known as the Krukenberg operation is a surgical technique that converts a forearm stump into a pincer.
End bearing : pressure born at the end of the amputated limb
2.
Cone bearing : pressure born elsewhere proximal to the amputated cite (by prosthesis)
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LOWER LIMB AMPUTATIONS RAY AMPUTATIONS
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SYME-AMPUTATION •
Disarticulation of the foot with removal of both malleoli.
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PIROGOFF’S AMPUTATION
Pre-Operative
Post Operative 16
CHOPART'S AMPUTATION •
Amputation of the foot at the midtarsal joint, the plantar soft tissues being preserved to make the flap
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LISFRANC-AMPUTATION •
Amputation of the foot between the metatarsus and tarsus.
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BELOW KNEE AMPUTATION
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GRITTI-STOKES AMPUTATION
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ABOVE KNEE AMPUTATION
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HINDQUARTER AMPUTATION •
An operation involving removal of an entire leg and part or all of the pelvis associated with it.
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COMPLICATIONS •
Hematoma
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Infection
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Flap necroses
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Joint contracture
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Neuromas
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Phantom limb
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Phantom pain 23
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CONCLUSION •
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Always try to treat the cause in order to avoid amputation If inevitable then don’t delay it Always consult experts in artificial limb centers for maximum benefit
