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amputation final ppt.pptx
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- 3. Principles of Below KneeAmputation W S R to Trans tibiofibular Amputation Presented by Dr JayanthKumar.S 2nd yr PGScholar Dept of PG Studies in ShalyaTantra JSS AyurvedaMedicalCollege, Mysuru-570028 Guided by Dr SiddeshAradhyamath Professor and Head Dept of PG Studies in ShalyaTantra JSS AyurvedaMedicalCollege, Mysuru-570028
- 4. CASE – 1 72yrMale C/O Wound in the B/L lower limbs H/O crush injury *3 months K/c/o DM
- 5. CASE-2 63yrs Female C/O painand small crack between the 1st and 2nd toe K/c/o DM
- 6. CASE- 3 53yrs Male C/opain in the foot while walking and sitting H/o Smoking K/c/o DM
- 7. Contents • History • Definition •Anatomy • Incidence • Surgical principles • Types of amputation • Types of flaps • Levels of amputation • Indication • Pre-operative • Operative • Post-operative • Complications • Prosthesis • Discussion • Conclusion • References
- 8. History • Rig-Veda isthe first recorded document about a prosthesis 1:116:15 • The foot of Vispala, the wife of Khela, was cut off like the wing of a bird and Aswini Kumaras gave her a metallic leg.
- 9. Neolithic humans – (Newstone Age 10,200 BC) Plato's (Symposium) (385 BC) Hippocrates (De Articularis) 400BC Acharya Sushruta 800 BC
- 10. 282 laws ofscaled punishment Hummurabi- 1754BCE Before the discovery of Anaesthesia classic circular cut
- 11. J. McKnight(1865) recorded survivorof a simultaneous triple amputation
- 12. Definition • “Amputation isa procedure where a part of the limb is removed through one or more bones ” Disarticulation;- • “Surgical removal of whole limb or part of the limb through a joint”
- 13. Incidence • Age • Traumatic •Gender • Limb
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- 20. Surgical principles • Tourniquet •Ex-sanguination • Levels of amputation • Skin flaps • Muscles • Muscle suturing – Myodesis – Myoplasty • Nerves
- 21. Surgical Principles contd.. •Blood vessels • Bone • Drains • Post operative procedures • Dressing - Conventional or soft • Positioning and elevation of the stump • Exercise • Wrapping • Prosthetic fitting and gait training
- 22. Surgical principles accordingto Ayurveda • Sushruta Samhita has given references on Amputation. • Poorvakarma – Dhoopana, Shastra payana, Madyapaana • Pradhanakarma – Chedana using Kharapatra • Pashchat karma – in cases of Raktasrava – pouring of hot Kshoudra ,Guda or Sneha over the stump to attain hemostasis. Kosha bandha, followed by vranopachara.
- 23. छे द्या भगन्दराग्रन्थिः श्लैन्िकन्िलकालकिः । व्रणवर्त्ाार्बादानि अर्ा: चर्ाकीलोऽन्थिर्ाांसगर्् ॥ र्ल्यां जतबर्नण र्ाांससांघातो गलर्बन्िका । स्नायब र्ाांसनसराकोिो वल्मीक ां र्तपोिकिः ॥ अध्रबषश्च उपदांर्श्च र्ाांसकन्ि अनिर्ाांसकिः ॥ (सब सू २५/३-४) कोििः पूतीभाविः । डल्हण सब सू २५/४ अपाक े षब तब रोगेषब कनििेषब न्थिरेषब च । स्नायब कोिानदषब तिा च्छे दिां प्राप्तर्बच्यते ॥ (सब नच १/३३) सांनभन्न जजाररत कोष्ठनर्रिःकपाला । जीवन्ि र्स्त्रनिहतैश्च र्रीरदेर्ैिः ॥ नछन्नैश्च सन्िभबज पादकरैरर्ेषैिः । येषाां र्र्ासब क ृ ता नवनविािः प्रहारािः ॥ (सब र्ा ६/३४)
- 24. • ततो गबग्गबलबअगरु सजारस वचा गौरसषापचूणणिः लवण निम्बपत्र नवनर्श्रैराज्ययबक्ैिः िूपयेत्, आज्यर्ेषेण चास्य प्राणाि् सर्ालभेत ॥ (सब सू ५/१८) • तेषाां पायिा नत्रनविा क्षारोदक तैलेषब । तत्र क्षार पानयतां र्रर्ल्यान्थि छे दिेषब, उदकपानयतां र्ाांसछे दिपाटिेषब, तैलपानयतां नसराव्यिि स्नायबच्छे दिेषब ॥ (सब सू ८/१२) • प्राक ् र्स्त्रकर्ाणश्चेष्टां भोजयेदातबरां नभषक ् । र्द्यपां पाययेन्मद्यां तीक्ष्णां यो वेदिाऽसहिः ॥ (सब सू १७/११) • नछन्नाां नििःर्ेषतिः र्ाखाां दग्ध्वा तैलेि र्बन्िर्ाि् । र्ध्नीयात् कोर्र्िेि प्राप्तां कायं च रोपणर्् ॥ (सब नच २/३७)
- 25. Types of Amputation Closed–Elective procedure. • The Skin is closed primarily after amputation.
- 26. Open/Guillotine • Emergency procedure •The skin is not closed primarily and later, any one of the closure methods like secondary closure, reamputation or plastic repair follows it • Indication- severe infection - severe crush injury
- 27. Skin flaps • Askin flap is healthy skin and tissue that is partly detached and moved to cover a nearby wound Skewed flap Long posterior skin flap
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- 29. Determination of Levels ofAmputation
- 30. Clinically • Disease progress •Lowest palpable pulse • Skin colour and temperature • Prosthesis available • Easy movement
- 31. Investigations • X-ray • USGDoppler or CT-Angiogram • Ankle-brachial pressure index > 0.5. • Compression pressure at the calf >65mmHg. • Transcutaneous oxygen measurement >40mmHg. • Skin perfusion pressure >40mmHg - laser doppler flowmetry.
- 32. • Pre-operative • Operative •Post-operative
- 33. • Assessment • Investigation •Consultation and physical fitness • High risk consent • Preparation of OT • Preparation of patient Pre-operative procedures
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- 44. Qualities of anideal stump • Should heal adequately. • Should have sufficient length to bear prosthesis. • Should have thin scar which does not interfere with prosthetic function. • Should have adequate adjacent joint movement. • Should have adequate blood supply.
- 45. Hematoma Skin flap necrosis Deformity Neuroma Phantomlimb Infection
- 46. Prosthesis Replacement or substitutionof a missing or a diseased part Classification Endoprosthesis – implants used to replace joints Exoprosthesis- replacement externally for part of the limb Types Temporary- used until the patient is fitted with permanent prosthesis Permanent- used permanently
- 47. Prosthesis for belowknee Amputation • Patellar tendon bearing- socket is made to fit exactly over the patellar tendon and the side of the tibial condyles • Conventional type- consist of thigh corset, side steel, knee joint, shin piece, ankle joint unit and footpiece
- 48. Jaipur Foot • Rubber-basedprosthetic leg • inexpensive • widely acceptable • widely used in India. • Dr. Pramod Sethi designed and manufactured artificial limbs, with the help of the skilled craftsmen Ram Chandra Sharma designed and developed it in 1968.
- 49. Discussion • The referencesrelated to amputation and use of prosthesis are found since the Vedic period. • Classics of Ayurveda gives the surgical principles of Amputation which holds good even in the present era. • The maintenance of Hemostasis by means of Agnikarma was in practice as per Acharya Sushruta, which is now modified and achieved by means of cauterization. • Even though the crude instruments have given way to more sophisticated ones now, the principles of amputation, achieving hemostatsis and wound care remains the same even now.
- 50. • The casespresented here are of different aetiology and clinical features, having Diabetes mellitus in common, ended up in Below knee Amputation after all other measures of conservative management failed. • Hence this presentation was a humble attempt to throw light on creating an awareness as how to approach a case, taking proper history, clinical examinations and investigations helps a surgeon to arrive at the right diagnosis, at the right time, to decide the right level of amputation to save the life of the patient. Discussion contd..
- 51. Conclusion • Amputation shouldnot be viewed as a failure of treatment rather as a reconstructive surgery. • Treatment of choice for an unreconstructable or a functionally unsatisfactory limb and first step toward a patient’s return to a more comfortable and productive life. • Amputation may result in a psychological trauma of permanent disability to the patient, which can be overcome by a holistic approach of treatment and counselling. • A major percent of the patients who underwent below knee amputation were afflicted with Diabetes mellitus. Hence maintaining a euglycemic state, lifestyle modifications and proper foot care throughout the life would reduce the incidence of Amputations in coming days.
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- 56. Marma Indrabasti Marma • Location-middleof the leg(calfmuscle) • Pramana-1/2angula • Classification- Shakha Gata Mamsa marma Kaalantara praanahara marma (Gradual life taking ) • Effect of injury-haemorrhage leading to death