Amputation

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Amputation

  1. 1. AMPUTATIONS
  2. 2.  DEFN-REMOVAL OF THE LIMB THROUGH A PART OF THE BONE.  DERIVED FROM LATIN WORD “AMPUTARE” MEANING ‘CUTTING AROUND’  INCIDENCE:AGE-50-75 YRS SEX-MALES[75%] LIMBS-LOWER LIMB[85%]
  3. 3. • POOR CIRCULATION -POVD, DIABETES • INJURY • TRAUMA FROST BITE,BURNS • INFECTIONS FULMINANT GAS GANGRENE,C/C OSTEOMYELITIS,INFECTED NON UNIONS,C/C INFECTED TROPHIC ULCER DEAD,DYING,DEVITALISED TISSUES.
  4. 4.  TUMOURS-OSTEOSARCOMA  CONGENITAL ANOMALIES most common indication in children
  5. 5. • CLOSED AMPUTATIONS FLAPS ARE FASHIONED AND ARE CLOSED PRIMARILY ALONG WITH SURGERY. • OPEN AMPUTATIONS FLAPS ARE NOT CLOSED PRIMARILY LATER REVISED AMPUTATION, REAMPUTATION OR PLASTIC REPAIR 1.GUILLOTINE TECHNIQUE ALL THE TISSUES ARE CUT AT THE SAME LEVEL.IN SEVERE CRUSH INJURIES AND SEVERE INFECTIONS.
  6. 6.  CIRCULAR AMPUTATION WITH FLAPS RETAINED FOR LATER DELAYED SUTURING. OTHER TYPES  REVISION AMPUTATION-for ideal stump  REAMPUTATION
  7. 7.  NON-END BEARING/SIDE BEARING  -Weight is taken up by the joint  END BEARING/CONE BEARING  -Weight is taken up by the body.
  8. 8. • HIGHER THE LEVEL OF AMPUTATION GREATER IS THE DIFF TO RESTORE ABILITY • AMPUTATION STUMP SHOULD BE LONG ENOUGH • IF A JOINT IS ARTHRODESED,SECTION AT JOINT LEVEL OR ABOVE • POVD-LEVEL SHOULD BE BELOW THE DISTAL MOST ARTERIAL PULSATION • IN ELDERLY FRAIL-BK AMPUTATION • OTHERWISE KNEE DISARTICULATION
  9. 9.  IN CLINICAL PRACTICE COLOUR AND TEMP OF THE SKIN BEFORE SURGERY APPEARANCE OF FREE CAPILLARY BLEEDING FROM CUT SURFACES ON OPERATION
  10. 10. • SHOULDER DISARTICULATION • SHORT ABOVE ELBOW • STANDARD ABOVE ELBOW • LOW ABOVE ELBOW • ELBOW DISARTICULATION • SHORT BELOW ELBOW • MEDIUM BELOW ELBOW • LONG BELOW ELBOW • WRIST DISARTICULATION
  11. 11.  BELOW KNEE-THRU THE TIBIA-FIBULA  SYME’S –THRU THE ANKLE JOINT  CHOPART’S-THRU THE MIDTARSAL JOINT  LISFRANC’S-THRU THE INTERTARSAL JOINTS.
  12. 12. • ANAESTHESIA-GA OR SAB • TOURNIQUET CONTRA INDICATED IN ISCHAEMIC LIMB AND ATHEROSCLEROSIS EXSANGUINATION PRIOR TO TOURNIQUET APPLICATION-CONTRA INDICATED IN INFECTED LIMBS AND MALIGNANCIES • SKIN FLAPS-GOOD COVERAGE,MOBILE,ADEQUATE LENGTH
  13. 13. • MUSCLES SECTIONED 5 CM DISTAL TO BONY SECTION 1.MYODESIS-SUTURING TO BONE (CI-ISCHAEMIC LIMB) 2.MYOPLASTY-OPPOSING MUSCLES ARE SUTURED ADVANTAGES- • SHAPE OF THE STUMP GOOD
  14. 14.  INSULATE CUT NERVE ENDINGS  MUSCLES ORIGINATING PROXIMALLY PROVIDE GOOD LEVERAGE  PHANTOM PAIN MAY BE PREVENTED  PREVENT RETRACTION &PAINFUL MUSCLE CONTRACTION
  15. 15. • BLOOD VESSELS DOUBLE LIGATION AND CUT • NERVES PULLED AND CUT SO THAT IT RETRACTS INTO THE STUMP • BONES PERIOSTEAL STRIPPING MINIMISED • DRAIN 48-72 HRS
  16. 16.  DRESSINGS 1.RIGID DRESSING-POP CAST DECREASED STUMP EDEMA,EARLY HEALING,LESS POST OP PAIN,TEMPORARY PROSTHETIC FITTING 2.SOFT DRESSING-SOFT BANDAGES AND ELASTOCREPE BANDAGES
  17. 17. • BEGIN ASAP • GOALS –REDUCE EDEMA, INCREASE STRENGTH, PREVENT CONTRACTURES, MAXIMISE FUNCTIONAL INDEPENDENCE. • BALANCE & COORDINATION ACTIVITIES FOR GAIT TRAINING. • WALKING AIDS • ALSO VOCATIONAL TRAINING, PAIN MNGMT, PSYCHO EDUCATION.
  18. 18. • HAEMATOMA • INFECTIONS • NECROSIS OF SKIN FLAPS • CONTRACTURES • PAINFUL NEUROMAS • PHANTOM LIMB
  19. 19. • IDEAL LENGTH • IDEAL SHAPE • MUSCULAR • GOOD POWER OF MUSCLES • NO FIXED DEFORMITY • FULL AND FREE MOVTS OF JOINT ABOVE • INFN FREE • NON ADHERENT INCISION SCAR • ABSENCE OF NEUROMA
  20. 20. CAN BE ACHIEVED BY • STUMP DRAINAGE • STUMP SPLINTING • STUMP BANDAGING • STUMP EXERCISES EARLY • STUMP HYGEINE
  21. 21.  MC AMPUTATION PERFORMED  A LONG POSTERIOR FLAP WITH SCAR PLACED OVER ANTERIOR ASPECT IS USED.  PROSTHESIS PLACEMENT IS BETTER HERE WITH GREATER RANGE OF MOVTS WITHOUT LIMP AND WITHOUT SUPPORT.  FIBULA SHOULD BE DIVIDED FIRST  TIBIAL STUMP SHUD BE BEVELED ANTRLY  POSTR MUSCLES ARE SUTURED ACROSS THE BONE ENDTO THE PERIOSTEUM IN FRONT.
  22. 22. ANKLE DISARTICULATION,REMOVAL OF MALLEOLI AND ANCHORING HEEL PAD TO THE WEIGHT BEARING AREA
  23. 23.  TWO POINTS 1.75 CM BELOW LAT MALLEOLUS AND 2.5 CM BELOW MED MALLEOLUS ARE JOINED INFRONT OF THE ANKLE AND ALSO VERTICALLY ACROSS THE HEEL PAD
  24. 24.  ANT INCISION DEEPENED-TALUS AND CALCANEUM REMOVED LEAVING ALL SOFT TISSUE IN THE FLAP  MEDIAL AND LATERAL MALLEOLI ALONG WITH A THIN SLICE OF TIBIA REMOVED  ADV-PATIENT CAN WALK WITHOUT A PROSTHESIS
  25. 25.  AMPUTATION THROUGH INTER TARSAL JOINTS  SEVERE EQUINUS DEFORMITY FRICTION IN ANTERO POSTERIOR PART OF THE STUMP.
  26. 26.  AMPUTATION THROUGH MID TARSAL JOINT  SUBTALAR FUSION AND ELONGATON OF TENDO ACHILLES
  27. 27. PIGROFF’S AMPUTATION  ANT PART OF CALCANEUM IS CUT ACROSS AND RAW BONE IS FIXED TO THE RAW UNDERSURFACE OF TIBIA  CALCANEAL TUBEROSITY -WEIGHT BEARING AREA
  28. 28. BOYD’S AMPUTATION  TALUS IS EXCISED  CALCANEUM IS ADVANCED AND ATTACHED TO THE RAW UNDERSURFACE OF TIBIA  STABLE LOAD BEARING SURFACE
  29. 29. THANK YOU

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