Introduction Classification Indications Types Complications Prevention Management References

1. Amputation
SUBMITTED BY: AMBREEN SADAF
BSOT02153003
SUBMITTED TO:MISS WAJEEHA ABDUL AHAD
18/03/19

2. 
 Introduction
 Classification
 Indications
 Types
 Complications
 Prevention
 Management
 References
Objectives

3. 

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

5. 

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..

9. 

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..

12. 

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

19. 
 Upper Limb Amputations
 Partial hand amputation
 Metacarpal Amputation
 Wrist disarticulation
 Below elbow amputation
 Elbow disarticulation
 Above elbow amputation
 Shoulder disarticulation and forequarter amputation
Types

20. 
 Lower Limb Amputations
 Partial foot amputation
 Ankle disarticulation
 Below knee amputations
 Through the knee amputations
 Above knee amputation
 Hip disarticulation
 Hemipelvectomy
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

25. 
 Exercise
 Compression socks
 Mobilization
 Rigid removable dressings
 Providing suitable positioning
 Providing skin care
Management

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

32. 
 Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., &
Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United
States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89, 422–
429. http://dx.doi.org/10.1016/j.apmr.2007.11.005
 Developed by Kristin L. Gulick, OTR/L, CHT, for the American
Occupational Therapy Association. Updated and copyright © 2016 by the
American Occupational Therapy Association. This material may be copied
and distributed for personal or educational uses without written consent.
For all other uses, contact copyright@aota.org.
 Current Diagnosis & Treatment in Orthopedics 3rd edition: by Harry
Skinner (Editor) Publisher: Appleton & Lange (June 20, 2003) • Campbel
Operative Orthopedics, 11th Edition
 CAMPBELL 13 TH EDITION [ CHAPTER 14- GENERAL PRINCIPLES OF
AMPUTATION ]
References

33. 