AMPUTATION

1. Amputations
Dr Imran Javed.
Associate Professor Surgery.
Fiji National University.

2. Definition.
 Amputation is defined as removal of the limb
or part of a limb through a part of the bone.
 Disarticulation is defined as removal of the
limb or part of the limb through the joint.

3. Causes
 Traumatic Amputation.
 Diabetic Amputation.
 Congenital deformities.
 Neoplastic conditions.
 Osteomyelitis.
 Gangrene or Impending Gangrene.
 Neurological conditions.
 Medico-legal reason.
 Social reasons.

4. Levels of Amputations in Lower
Limb.
 Hip Dis-articulation.
 Hind Quadrant Amputation.
 Sub Trochanteric Amputation.
 Above Knee Amputation.
 Knee Disarticulation.
 Through Knee Amputation.
 Below Knee Amputation.
 Through Ankle Amputation (Syme)
 Ankle Disarticulation.
 Trans-Tarsal Amputation (Lisfranc).
 Trans meta-tarsal Amputation.
 Toe Amputation (Ray).

5. Levels of Amputation in Upper
Limb.
 Shoulder Disarticulation.
 Fore-Quadrant Amputation.
 Trans-Humeral Amputation.
 Through Elbow Amputation.
 Elbow Dislocation.
 Proximal & Distal Forearm Amputations.
 Wrist Disarticulation.
 Hand Amputations.
 Trans-Carpal Amputation.
 Trans-Metacarpal Amputation.
 Phalanx Amputation.
 Digital Amputation.

6. Pre Operative Consideration.
 Assessment of Level of Amputation.
 Marking of site & Tagging of side.
 Psychological Counseling.
 Consent.
 Arrangement of Cross Matched Blood.
 Prosthesis planning.
 Rehabilitation Planning.
 Medico-legal issues.
 Employment Consideration.

7. Amputation Level Prevalence.

8. Specialty Involved
 General Surgery.
 Orthopedics.
 Vascular Surgery.
 Plastic Surgery.
 Anesthesia.
 Internal Medicine.
 Forensic Medicine.
 Rehabilitation Medicine.

9. Anesthesia
 Depends on level of Amputation & cause of
amputation.
 General Anesthesia for major limb amputation.
 Regional Anesthesia for mid-limb amputation.
 Augmented local anesthesia for minor digital
amputations.
 For Diabetic Distal amputation may be some time
without anesthesia if no pain.

10. Timelines
 Primary amputation (within first 24 hours)
 Secondary amputation (7-8 days after injury)
 Re-amputation (repeated amputation)

11. Steps of Limb Amputations.
 I. Incision Through soft tissue
 II. Cutting of periosteal and bone tissue.
 III. Making an adequate stump.

12. Types of Amputations
(according to soft tissues cutting)
 1. Flap amputations:
- single-flap amputation
- double-flap amputation
 2. Circular amputations:
- one-step (guillotine) amputation
- two-step amputation (variety – “cuff”
method of forearm amputation)
- three-step (conical-circular)
amputation

13. Fish Mouth Incision for AKA.

14. Marking-out of skin flaps &
Tourniquet.

15. Stages of Trans-femoral
Amputation

16. Cutting of Bone

17. Exposure and Ligation of Main
Vessels

18. Stump Formation & Myoplasty

19. Stump Bandage

20. Rehabilitation
There are 5 Stages of Rehabilitation:
Healing and Starting Physiotherapy
 Visiting the Prosthetist
Choosing an Artificial Limb
Learning to Use your Artificial Limb
Life as a New Amputee

21. Prosthesis

22. Below Knee Amputations

23. Ankle & Foot Amputations.

24. Complications of Amputation
 massive hemorrhage
 infection
 rash, blisters, and skin breakdown
 Pneumonia, DVT & Bedsores due to
Immobility.
 formation of nerve cell tumors (neuromas)
 disfigured stump
 Joint Contractures.
 Muscular Dystrophy.
 terminal necrosis of bone
 phantom pain
 Gangrene

25. Upper Limb Amputations

26. Hand Amputations

27. Upper Limb Prosthesis

28. Bilateral Lower Limb Amputees &
Olympics