4.
DEFINITION:
Amputation is the removal of a limb by trauma,
medical illness, or surgery.
When it is through a joint then it is known as disarticulation
It is not a failure of surgery but a reconstructive procedure
Goal is surgical reconstruction that maintains most functional limb
possible
Introduction
6.
350,000-1 mil amputees
20,000-30,000 new amputees a year
> age 50-50 years
More in Lower limbs
More in males
Epidemiology
7.
Hand & Partial-Hand Amputations
Finger, thumb or portion of the hand below the wrist
Wrist Disarticulation
Limb is amputated at the level of the wrist
Trans-radial (below elbow amputations)
Amputation occurring in the forearm, from the elbow
to the wrist
Amputation levels
( upper limbs )
8.
Trans-humeral (above elbow amputations)
Amputation occurring in the upper arm from the
elbow to the shoulder
Shoulder Disarticulation
Amputation at the level of the shoulder, with the
shoulder blade remaining.
Forequarter Amputation
Amputation at the level of the shoulder in which both
the shoulder blade and collar bone are removed
Continued..
10.
Foot Amputations
Amputation of greater toes and other toes
Amputation through the metatarsal bones
Lisfranc`s operation : at the level of the tarsometatarsal
joints
Chopart`s operation : through the metatarsal joints
Transtibial Amputations (below the knee)
Amputation occurs at any level from the knee to the
ankle
Amputation levels
( lower limbs )
11.
knee Disarticulation
Amputation occurs at the level of the knee joint
Trans-femoral Amputations (above knee )
Amputation occurs at any level from the hip to knee
joint
Hip Disarticulation
Amputation is at the hip joint with the entire thigh and
lower portion of the leg being removed.
Continued..
13.
To get rid of all necrotic, infected & painful tissue.
To have a wound that heals successfully.
To have an appropriate remnant stump that is able to
accommodate a prosthetic.
Goals of amputation
14.
Ascertain indication
Site of amputation
General medical condition
Rehabilitation potential
Counselling
Consent
Optimization
Pre-Operative Assessment To
15.
Assessment of
The affected limb
The unaffected limb
The patient as a whole is conducted thoroughly.
Assessment of physical, social & psychological status
of the patient should be made
Pre Operative
Assessment
16.
CLASSIFICATION:
Amputation is classified into two categories:
Open amputation
Guillotine
Modified guillotine
Closed amputation
Revised
Planned
Classification
17.
INDICATIONS:
Dead limbs
Severe trauma
Peripheral vascular disease
Burns
Frostbite
Indications
18.
Dangerous limb
Crush injury
Malignancy
Lethal sepsis
Damned nuisance
Gross deformity
Recurrent sepsis
Loss of function
Continued
21.
Amputations in children is divided into two general
categories—congenital (60%) and acquired (40%)
Amputations In Children
Amputations In Children Congenital
Congenital deficiencies of the long bones
Amniotic band syndrome
Exposure to teratogens ( thalidomide )
AMPUTATIONS IN CHILDREN
22.
Polydactyly
Macrodactyly
Congenital pseudo arthrosis of the tibia and fibula,
radius and ulna Acquired
Secondary to trauma
Neoplasm
Infection.
Vascular disease
Continued..
23.
Early
Bleeding and haematoma
Flap necrosis
Surgical wound infection
Gas gangrene
Late
Phantom pain
Phantom limb
Joint deformity
Complications
24.
Maintain circulation through movement of other
good limbs.
Deep breathing, coughing and postural drainage to
prevent chest complications.
Pressure mobility of all the joints.
Prevention
26.
Prosthetics It is a replacement of substitution of a
missing or a diseased part
Types of Prosthesis
BELOW KNEE
KNEE DISARTICULATION
ABOVE KNEE
HIP DISARTICULATION
PROSTHETICS LOWER EXTREMITY
Prosthetics
27.
Ideal prosthesis
1. Fits comfortably
2. Function well
3. Looks presentable
4. Fit as soon after the operation
Benefits
28.
Goal is to achieve useful residual limb in an
individual who is active with a positive attitude an
continues to be a productive member of society
Goal of prosthetics
29.
Occupational therapy is a critical rehabilitation
component, providing support to individuals and
facilitating optimum performance of daily life
activities as well as quality of life.
A therapeutic team that includes the skills of an
occupational therapy practitioner will provide the
client with the most successful rehabilitation and
prosthetic training.
OT benefits in amputee
30.
Upper-limb amputation not only affects a person’s
physical functioning, but also psychological and
emotional well-being. Occupational therapy
practitioners recognize the complexity of this
condition and use a holistic approach that
emphasizes the client’s perspective the roles and
activities they meaningful, and personal experiences
and value in developing intervention plans and
goals.
Continued..
31.
Identifying the client’s functional goals, which can
include self-care, home management, work tasks, driving,
child care, and leisure activities, and offering
modifications to complete these goals if required
Analyzing tasks and providing modifications to achieve
functional goals
Providing education on compensatory techniques and
equipment to accomplish tasks and activities
Providing prosthetic training
Identifying and addressing psychosocial issues
Adaptive equipment and assistive devices are provided.
OT management
Upper Limb Amputations Upper limb amputations vary from the partial removal of a finger to the loss of the entire arm and part of the shoulder. The following list provides a summary of the typical forms of upper limb amputation: • Partial hand amputation - amputations can include fingertips and parts of the fingers. The thumb is the most common single digit loss. The loss of a thumb inhibits the ability to grasp, manipulate or pick up objects grasping ability. When other fingers are amputated, the hand can still grasp but with less precision. • Metacarpal Amputation – this involves the removal of the entire hand with the wrist still intact • Wrist disarticulation – this form of amputation involves the removal of the hand and the wrist joint • Below elbow amputation (transradial) – the partial removal of the forearm below the elbow joint • Elbow disarticulation – the amputation of the forearm at the elbow. • Above elbow amputation (transhumeral) - the removal of the arm above the elbow • Shoulder disarticulation and forequarter amputation is the removal of the entire arm including the shoulder blade and collar bone.
Lower Limb Amputations Lower limb amputations vary from the partial removal of a toe to the loss of the entire leg and part of the pelvis. The following list provides a summary of the typical forms of lower limb amputation: • Partial foot amputation – this commonly involves the removal of one or more toes. This amputation will affect walking and balance. • Ankle disarticulation – an amputation of the foot at the ankle, leaving a person still able to move around without the need for a prosthesis • Below knee amputations (transtibial) – an amputation of the leg below the knee that retains the use of the knee joint. • Through the knee amputations – the removal of the lower leg and knee joint. The remaining stump is still able to bear weight as the whole femur is retained • Above knee amputation (transfemoral) - an amputation of the leg above the knee joint • Hip disarticulation – the removal of the entire limb up to and including the femur. A variation leaves the upper femur and hip joint for better shape/profile when sitting • Hemipelvectomy (transpelvic) – the removal of the entire limb and the partial removal of the pelvis