Amputation is the complete removal of an injured or deformed body part. It has been performed since ancient times, often crudely without anesthesia to treat war injuries. Modern amputation techniques focus on debriding nonviable tissue, preventing neuroma formation, achieving hemostasis and wound closure. Postoperative management aims for prompt healing while controlling pain, edema and preventing contractures through rehabilitation and sometimes prosthetics.

1. Amputation Dr. Abdullah-Al-Mamun

2. ‘ DDD’ Dead Deadly Dam Nuisance Indications: Amputation

3. 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. Nomenclature. Amputation

4. History Most 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

5. Etiology Trauma Burns Peripheral Vascular Disease Malignant Tumors Neurologic Conditions Infections Congenital Deformities Amputation

6. Trauma Amputation

7. Malignant Tumor Amputation

8. Gangrene Amputation

9. Crush Amputation

10. Peripheral Vascular Disease Amputation

11. Congenial Anomaly Polydactyly Amputation

12. Scleroderma Amputation

13. Determination of level Zone of Injury (trauma) Adequate margins (tumor) Adequate circulation (vascular disease) Soft tissue envelope Bone and joint condition Control of infection Nutritional status Amputation

14. Debridement of all Nonviable tissue and foreign material Several debridements may be required Primary wound closure often contraindicated High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viable Techniques Amputation

15. Nerve Prevent neuroma formation Draw nerve distally, section it, allow it to retract proximally Skin Opportunistic flaps Rotation flaps Tension free Skin grafts Techniques Amputation

16. Bone: Choose appropriate level Smooth edges of bone Narrow metaphyseal flare for some disarticulations Postoperative Dressing: Soft Rigid Amputation Techniques

17. Goals of Postoperative Management Prompt, uncomplicated wound healing Control of edema Control of Postoperative pain Prevention of joint contractures Rapid rehabilitation Techniques Amputation

18. Techniques… Few examples Amputation

19. Techniques… Few examples Amputation

20. After 12 months Techniques… Few examples Amputation

21. Goals of Postoperative Management Prompt, uncomplicated wound healing Control of edema Control of Postoperative pain Prevention of joint contractures Rapid rehabilitation Techniques Amputation

22. Rehabilitation and Prosthetics Amputation

23. Goals of Postoperative Management Prompt, uncomplicated wound healing Control of edema Control of Postoperative pain Prevention of joint contractures Rapid rehabilitation Techniques Amputation

24. 1. Residual Limb Shrinkage and Shaping 2. Limb Desensitization 3. Maintain joint range of motion 4. Strengthen residual limb 5. Maximize Self reliance 6. Patient education: Future goals and prosthetic options Rehabilitations. Amputation

25. Up to 2/3 of amputees will manifest postoperative psychiatric symptoms Depression Anxiety Crying spells Insomnia Loss of appetite Suicidal ideation Psychological stress. Amputation

26. Prosthetics Amputation Myoelectric Surface EMG Activation delay Neuroprosthetics Investigational Passive Cosmetic Body Powered Harnesses and cables

27. Preparation Good Surgical Technique Rehabilitation Early Prosthetic Fitting Team Approach Vocational and Activity Rehabilitation Management of Amputee Amputation