Amputation in Surgery

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Amputation is of the common surgical procedure done in the ER. This is also common in various routine cases. This presentation covers various aspects of amputation including steps of below knee amputation. The background has been changed from the previous one to hide the brutality of this procedure.

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Amputation in Surgery

  1. 1. Amputation<br />Dr. Muhammad shahiduzzaman<br />Professor and Head<br />Orthopaedics and Traumatology<br />Dhaka Medical College hospital<br />
  2. 2. Derived from the Latin amputare.<br />"to cut away", from ambi- ("about", "around") and putare ("to prune").<br />Amputation is the complete removal of an injured or deformed body part.<br />The English word "amputation" was first applied to surgery in the 17th century.<br />Amputation<br />Nomenclature.<br />
  3. 3. History<br />Most ancient of surgical procedure.<br />Historically were stimulated by the aftermath of war.<br />It was a crude procedure by which limb was rapidly severed from unanesthetized patient.<br />The open stamp was then crushed or dipped in boiling oil to obtain hemostasis.<br />Hippocrates was the first to use ligature.<br />Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis.<br />Amputation<br />
  4. 4. Condition leading to amputation<br />Trauma<br />Burns<br />Peripheral Vascular Disease<br />Malignant Tumors<br />Neurologic Conditions<br />Infections<br />Congenital Deformities<br />Amputation<br />
  5. 5. ‘DDD’<br />Dead<br />Deadly<br />Dam Nuisance <br />Amputation<br />Indications:<br />
  6. 6. Amputation<br />Trauma<br />
  7. 7. Amputation<br />Malignant Tumor<br />
  8. 8. Amputation<br />Gangrene<br />
  9. 9. Crush<br />Amputation<br />
  10. 10. Peripheral Vascular Disease<br />Amputation<br />
  11. 11. Congenial Anomaly<br />Polydactyly<br />Amputation<br />
  12. 12. Scleroderma<br />Amputation<br />
  13. 13. Determination of level<br />Zone of Injury (trauma)<br />Adequate margins (tumor)<br />Adequate circulation (vascular disease)<br />Soft tissue envelope<br />Bone and joint condition<br />Control of infection<br />Nutritional status<br />Amputation<br />
  14. 14. Level of Amputation<br />
  15. 15. Debridement of all Nonviable tissue and foreign material<br />Several debridements may be required<br />Primary wound closure often contraindicated<br />High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viable<br />Techniques<br />Amputation<br />
  16. 16. Nerve<br />Prevent neuroma formation<br />Draw nerve distally, section it, allow it to retract proximally<br />Skin<br />Opportunistic flaps<br />Rotation flaps<br />Tension free<br />Skin grafts<br />Techniques<br />Amputation<br />
  17. 17. Techniques<br />Bone:<br />Choose appropriate level<br />Smooth edges of bone<br />Narrow metaphyseal flare for some disarticulations<br />Postoperative Dressing:<br />Soft<br />Rigid<br />Amputation<br />
  18. 18. Goals of Postoperative Management<br />Prompt, uncomplicated wound healing<br />Control of edema<br />Control of Postoperative pain<br />Prevention of joint contractures<br />Rapid rehabilitation<br />Techniques<br />Amputation<br />
  19. 19. Below Knee Amputation<br />
  20. 20. Principles of techniques<br /><ul><li>A tourniquet, Unless there is a arterial insufficiency.
  21. 21. Skin Flaps: Combined length must be 1.5X width.
  22. 22. Muscles are divided distal to the proposed site of bone section.
  23. 23. Myodesis: opposing groups are sutured over the bone end to each other and with the periosteum.
  24. 24. Osteomyodesis: Anchoring opposing muscles group with the bone trough drill hole and sutures.</li></li></ul><li>Principles of techniques…<br />Nerve are divided proximal to the bone cut to ensure nerve end do not bear weight.<br />Tibia is swan across the proposed level and front of the tibia is usually beveled and filed to create a smooth rounded contour.<br />Fibula is cut 3 cm shorter. <br />The main vessels are tied.<br />The tourniquet is removed and every<br /> bleeding point meticulously ligated.<br />The skin is sutured carefully without tension.<br />Suction drain is advised.<br />Soft figure of eight bandage is given.<br />
  25. 25. BK Amputations:Post operative follow up after 14 days<br />Amputation<br />
  26. 26. Techniques… Few examples<br />Amputation<br />
  27. 27. Techniques… Few examples<br />Amputation<br />
  28. 28. Techniques… Few examples<br />After 12 months<br />Amputation<br />
  29. 29. Rehabilitation and Prosthetics<br />Amputation<br />
  30. 30. Rehabilitations.<br />Amputation<br />1. Residual Limb Shrinkage and Shaping<br />2. Limb Desensitization<br />3. Maintain joint range of motion<br />4. Strengthen residual limb<br />5. Maximize Self reliance<br />6. Patient education: Future goals and prosthetic options<br />
  31. 31. Psychological stress.<br />Amputation<br />Up to 2/3 of amputees will manifest postoperative psychiatric symptoms<br />Depression<br />Anxiety<br />Crying spells<br />Insomnia<br />Loss of appetite<br />Suicidal ideation<br />
  32. 32. Prosthetics<br />Amputation<br />
  33. 33. Management of Amputee<br />Preparation<br />Good Surgical Technique<br />Rehabilitation<br />Early Prosthetic Fitting<br />Team Approach<br />Vocational and Activity Rehabilitation<br />Amputation<br />
  34. 34. Thank You<br />

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