Amputation is the surgical removal of a limb or part of a limb. It has been performed for thousands of years as a medical procedure and punishment. The most common modern indications for amputation are peripheral vascular disease, diabetes, and severe trauma. A study in Rwanda found the prevalence of amputation to be 3.08% of all surgeries, with the majority performed for gangrene secondary to peripheral vascular disease. Below knee amputation was the most common procedure, and 87.9% of patients had an uneventful recovery, though complications like phantom limb pain and need for re-amputation can occur. Amputation, while often a last resort, remains a life-saving procedure for conditions that could otherwise prove

1. AMPUTATION
• PRESENTER: BIMENYIMANA Phocas, medical student, Doc3, UR, RMH
• Supervisor : Dr Mutoniwase Bernard, general surgery graduate, RMH

2. INTRODUCTION
The word Amputation is derived from the Latin word amputare "to cut away“
From ambi (about, around) and putare (to-prune)
Amputation is Surgical removal of limb or part of the limb through a bone or
multiple bones.
Disarticulation: separation of two bones at their joint.
Stump: Part of the limb that is left below the healthy joint
Flap: the muscular and cutaneous tissues that are made to cover the end of
the bone
Amputee: a person whose limb amputated.

3. Historical back ground
• Amputation is the most ancient of all surgical procedures
• Amputation of a hand or foot was a common punishment in many of
the older so-called civilized societies and is still carried out today in
some countries.
• Hippocrates was the first to use ligature
• Ambroise Pare a French military surgeon introduced artery forceps.
He also designed prosthesis.
• The English word "amputation" was first applied to surgery in the
17th century.
• Morels – 1674 : introduced Tourniquet.

4. Epidemiology
• In a study done at UTHB( university teaching hospital of BUTARE) from 1st
January 2009 to 31st March, 2012. The records of 107 limb amputations
performed in patients admitted at CHUB over a period of 2 years and 3
months were reviewed.
• Results: Out of 3466 operated cases in Surgery Department, there were
107 limb amputations accounting for 3.08% of all operations performed
during the study period.
• Females accounted for 29.9% cases. The mean age was 44.7±21.5 years.
The commonest indication was gangrene in 43.95% especially dry
gangrene with 22.43%. The most common level was below knee
amputation (BKA) with 37.38% of cases. The outcome of the 107 patients
amputated: 87.9% had uneventful recovery, 7.5% were re-operated and
4.7% died.

5. Cont’d
Conclusion:
• The prevalence of limb amputation was 3.08% with the commonest
indication as gangrenes most often secondary to peripheral vascular
disease.
• Below knee amputation was the most performed procedure.
• The majority (87.9%) of the patients had uneventful recovery.
• The postoperative mortality rate was 4.7%.

6. cont’d
• More than 90% amputations are due to PVD in aged population.
• Trauma > Malignancy is more common in younger patents.
• The only Absolute indication for amputation is irreversible ischemia.
• The most common indication for amputation. with or without
diabetes. Most frequently occurs in individuals age 50 to 75 year.
• Approximately half of amputations for peripheral vascular disease are
performed on patients with diabetes.
• 1.7 million individuals in the United States with an amputation
• 80% of amputations are performed for vascular insufficiency

7. When and why to amputate?
INDICATIONS

9. Back to CHUB

11. Types of amputations
According to the level of amputation

12. Lower extremity amputation

13. Lower extremity amputation cont’d

14. Upper extremities amputation

15. COMPLICATIONS
• Deep vein thrombosis
• Stump hematoma
• Need for re amputation
• Phantom limb pain
• Bone overgrouth
• Flection contractures
• Reflex sympathetic dystrophy
• Neuroma
• Prosthetic pain
• Emotional response of the amputee

16. Take a home message
• Amputation is the most ancient of all surgical procedures
• More than 90% amputations are due to PVD in aged population
• Approximately half of amputations for peripheral vascular disease are
performed on patients with diabetes.
• Indications of amputation are summarized in 3Ds: Dead (or Dying),
Deadly/dangerous and Dead loss
• Nerves should be pulled out and transected as high as possible to prevent
neuromas and stump pain.
• Wound healing depends on vascular supply, nutritional status and immune
status, DM,…
• Many amputees develop phantom limb pain and psychological problems
few days after amputation

17. •Amputation is still often viewed as a failure of
treatment but can be the treatment of choice
and life saving procedure for severe trauma,
vascular disease and tumors.

18. References
1. Onuba O, Udoidiok E. The scope of amputation in the developing
countries. Postgraduate Doctor Africa 1989; 11(5):118-12
2. https://www.researchgate.net/publication/272833032_Prevalence
_Indications_Levels_and_Outcome_Limb_amputations_at_Universi
ty_Teaching_Hospital-
Butare_in_Rwanda/link/55f3352e08ae1d9803948bed/download
3. Uptodate.com
4. orthobullets.com
5. https://www.researchgate.net/publication/272487981_Lower_Lim
b_Amputations