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AMPUTATIONS

Lecture by:

Lt Col(R)

M. AZHAR QURESHI

A/P Surgery

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DEFINITION

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

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WHY TO AMPUTATE ??

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A useful and painless artificial limb is

better than a painful and non functional

natural limb

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INCIDENCE

vascular/

diabetes83%

trauma10%

tumors3% infections1%

Neurological/

congenital3%

Other4%

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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. DeadLoss: When due to relentless ischemic pain, paralysis, trauma or

deformity the limb can not be used or it hinders its normal

function

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GENERAL PRINCIPLES OFAMPUTATIONS

Treat the cause if possible and try to save the limb

Get informed consent

Discuss the level with experts in regional limb fittingcenter

General anesthesia is preferable

Try to preserve joints

Try to preserve epiphysis in children

For tumors confirm the diagnosis with tissue biopsy

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PREPARATION

Prophylactic antibiotics

Clean the limb and seal off infected or necrotic area

Arrange for disposal of limbs

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

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STUMP LENGTH

In the upper arm and fore arm a 20 cm stump

is recommended

For lower leg a 14 cm tibial stump is ideal

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 optimum10

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UPPER LIMB AMPUTATIONS

Fingers

Hands

Arm and Fore arm

Krukenberg amputation:The Krukenberg procedure alsoknown as the Krukenbergoperation is a surgical technique

that converts a forearm stumpinto a pincer.

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UPPER LIMB AMPUTATIONS (Contd.)

1. Fore quarter amputation

2. Shoulder disarticulation

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LOWER LIMB AMPUTATIONS

1. 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

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RAY AMPUTATIONS

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SYME-AMPUTATION

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Disarticulation of the foot with removal of both malleoli.

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PIROGOFFS AMPUTATION

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CHOPART'S AMPUTATION

Amputation of the foot at the midtarsal joint, theplantar soft tissues being preserved to make theflap

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LISFRANC-AMPUTATION

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Amputation of the foot between the metatarsus andtarsus.

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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

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An operation involving removal of an entire leg and partor all of the pelvis associated with it.

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COMPLICATIONS

Hematoma

Infection

Flap necroses

Joint contracture

Neuromas

Phantom limb

Phantom pain

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CONCLUSION

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Always try to treat the cause in order to avoidamputation

If inevitable then dont delay it Always consult experts in artificial limb centers for

maximum benefit

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QUESTIONS ??

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