Amputation, derived from the Latin word meaning 'to cut away', is the complete removal of an injured or deformed body part, with historical roots stemming from war-related surgical practices. Various conditions, such as trauma, malignant tumors, and vascular diseases, may necessitate amputation, with specific techniques and postoperative management aimed at facilitating healing and rehabilitation. Effective management includes proper surgical techniques, pain control, and psychological support to address potential issues among amputees.

1. AmputationDr. Muhammad shahiduzzamanProfessor and HeadOrthopaedics and TraumatologyDhaka Medical College hospital

2. Derived from the Latin amputare."to cut away", from ambi- ("about", "around") and putare ("to prune").Amputation is the complete removal of an injured or deformed body part.The English word "amputation" was first applied to surgery in the 17th century.AmputationNomenclature.

3. HistoryMost ancient of surgical procedure.Historically were stimulated by the aftermath of war.It was a crude procedure by which limb was rapidly severed from unanesthetized patient.The open stamp was then crushed or dipped in boiling oil to obtain hemostasis.Hippocrates was the first to use ligature.Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis.Amputation

4. Condition leading to amputationTraumaBurnsPeripheral Vascular DiseaseMalignant TumorsNeurologic ConditionsInfectionsCongenital DeformitiesAmputation

5. ‘DDD’DeadDeadlyDam Nuisance AmputationIndications:

6. AmputationTrauma

7. AmputationMalignant Tumor

8. AmputationGangrene

9. CrushAmputation

10. Peripheral Vascular DiseaseAmputation

11. Congenial AnomalyPolydactylyAmputation

12. SclerodermaAmputation

13. Determination of levelZone of Injury (trauma)Adequate margins (tumor)Adequate circulation (vascular disease)Soft tissue envelopeBone and joint conditionControl of infectionNutritional statusAmputation

14. Level of Amputation

15. Debridement of all Nonviable tissue and foreign materialSeveral debridements may be requiredPrimary wound closure often contraindicatedHigh voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viableTechniquesAmputation

16. NervePrevent neuroma formationDraw nerve distally, section it, allow it to retract proximallySkinOpportunistic flapsRotation flapsTension freeSkin graftsTechniquesAmputation

17. TechniquesBone:Choose appropriate levelSmooth edges of boneNarrow metaphyseal flare for some disarticulationsPostoperative Dressing:SoftRigidAmputation

18. Goals of Postoperative ManagementPrompt, uncomplicated wound healingControl of edemaControl of Postoperative painPrevention of joint contracturesRapid rehabilitationTechniquesAmputation

19. Below Knee Amputation

20. Principles of techniquesA tourniquet, Unless there is a arterial insufficiency.

21. Skin Flaps: Combined length must be 1.5X width.

22. Muscles are divided distal to the proposed site of bone section.

23. Myodesis: opposing groups are sutured over the bone end to each other and with the periosteum.

24. Osteomyodesis: Anchoring opposing muscles group with the bone trough drill hole and sutures.Principles of techniques…Nerve are divided proximal to the bone cut to ensure nerve end do not bear weight.Tibia is swan across the proposed level and front of the tibia is usually beveled and filed to create a smooth rounded contour.Fibula is cut 3 cm shorter. The main vessels are tied.The tourniquet is removed and every bleeding point meticulously ligated.The skin is sutured carefully without tension.Suction drain is advised.Soft figure of eight bandage is given.

25. BK Amputations:Post operative follow up after 14 daysAmputation

26. Techniques… Few examplesAmputation

27. Techniques… Few examplesAmputation

28. Techniques… Few examplesAfter 12 monthsAmputation

29. Rehabilitation and ProstheticsAmputation

30. Rehabilitations.Amputation1. Residual Limb Shrinkage and Shaping2. Limb Desensitization3. Maintain joint range of motion4. Strengthen residual limb5. Maximize Self reliance6. Patient education: Future goals and prosthetic options

31. Psychological stress.AmputationUp to 2/3 of amputees will manifest postoperative psychiatric symptomsDepressionAnxietyCrying spellsInsomniaLoss of appetiteSuicidal ideation