Amputation is the surgical removal of a limb or part of a limb. It has been performed for centuries as a treatment for trauma, infection, tumors, and other conditions. The procedure involves carefully marking the incision site, administering antibiotics, ligating blood vessels, and creating a conical stump for prosthesis fitting. Factors like adequate blood supply, joint mobility, and wound healing must be considered when determining the appropriate amputation level. With modern techniques, amputation allows many patients to regain mobility and independence through prosthetic devices.

1. AMPUTATION

2. DEFINITION
“Surgical removal of limb or part of the limb
through a bone or multiple bones”
• Derived from the Latin amputare - "to cut away“
• From ambi- (about, around) and putare (to-prune)

3. HISTORY
• Most ancient of surgical procedure.
• Historically were stimulated by the
aftermath of war.
• It was a crude procedure - limb was
rapidly severed from unanesthetized
patient.
• The open stump 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.

4. INDICATION

5. Trauma
Peripheral Vascular Disease Scleroderma

6. Malignant Tumor
Gangrene
Congenital
Anomaly

7. PRINCIPLE OF AMPUTATION
Should mark the incision Should give prophylactic antibiotics
Should avoid tourniquet in arterial
occlusive diseases
Should ensure the adequate blood supply to
the flaps
Should ligate the blood vessel securely
to avoid hematoma and then infection
Should not clamp the nerves but they are
pulled down and transected as high as
possible.
Should saw the anterior part of the bone
obliquely to give smooth anteriro bevel
which prevent pressure necrosis of the flap
Should excise the bulky muscle to give
a good conical stump
Should use absorbable suture to unite
the muscle ends
Should drain the cavity with suction drain
which is brought up through the skin clear of
the wound

8. LEVEL OF AMPUTATION
• Zone of Injury (trauma)
• Adequate margins (tumor)
• Adequate circulation (vascular disease)
• Soft tissue envelope
• Bone and joint condition
• Control of infection
• Nutritional status
Level of amputation depends not only upon the extent of the disease but also function
desired in the remaining stump. These differs markedly in the upper and lower limb

9. IDEAL STUMP
Should have
1. Sufficient length to bear prosthesis.
• Below knee 7.5 - 12.5 cm from tibial tuberosity
• Above & Below Knee 20cm stump
• Above Knee - 23 cm from greater trochanter
2. Conical and Rounded
3. Tenderness Free
4. Adequate joint movement, blood supply.
5. Heal adequately by 1st intention
6. Scar - thin, placed where it is not exposed to pressure,
freely mobile over underlying tissues - not interfere with
prosthetic function
7. Skin should not be infolded and no redundant soft tissue.
8. Adequate muscle padding - adequate movement

10. Evaluation of patients who need amputation
• Check for anemia - correct by blood or packed cells
transfusion
• Infection - control using antibiotic and proper dressing
• Decision of which limb to be amputated
• Decision of level of amputation by :
– Skin temperature
– Arterial doppler
• Informed consent should be taken
• Psychological counselling
• Plan for prosthesis & rehabilitation by physiotherapist &
rehabilitation team.

11. • Circular incision
• Elliptical/Oval
• Racquet incision
• Amputations using flaps
INCISIONS
Depending upon the site of the level of amputation and
keeping in mind the blood supply of the part

12. AMPUTATION IN LEG
• RAY AMPUTATION
• Toe Amputation
• With Head Of Metatarsal

13. AMPUTATION IN LEG
Gillies’ Amputation
• Trans Metatarsal
• Proximal To Neck Of Metatarsal, Distal To
Base
Lisfranc’s
• Tarsometatarsal
• The tarso metatarsal joint is disarticulated

14. AMPUTATION IN LEG
Chopart’s Amputation
• Mid Tarsal Amputation
• Disarticulation Of
• Talo-navicular & Calcaneo Cuboid Joints
• Tibialis Anterior Sutured To Talus
• Long Volar Flap And Immobilisation – 6wks

15. AMPUTATION IN LEG
Syme’s Amputation
• Removal Of Foot With Calcaneum
• Retaining Heel Flap
• Bone At Tibia & Fibula Just Above
Ankle Joint
• Elephant Boot
Pirogoff's amputation
• Amputation of the foot at the ankle
• part of the calcaneus being left in the stump
The Boyd procedure
• Provides a broad weight-bearing surface of the heel by creating an arthrodesis
between the distal tibia and the tuber of the calcaneus
• Compared to a Syme's amputation, it provides more length and better preserves
the weight-bearing function of the heel pad.
• Its increased complexity and morbidity have made it less used now than the Syme's
amputation.

16. AMPUTATION IN LEG
Above knee A/K amputation
• Equal anterior and posterior flaps
• Ideal femur stump should be 25 cms long.
• Not done in children as growing epiphysis of
femur is in lower end.
• Minimum stump should be 10cms long.
• It is technically easy, healing chances are
better and faster.
• Cosmetic results poor, prosthesis fitting is not
• proper, pt limps while walking and need
support

17. B E L O W K N E E A M P U TAT I ON ( B U RG E S S ’ )
• Min. Stump Length :
• 8 Cm From Tibial Tuberosity
(14-17 Cm Is Good)
• Long Posterior Flap
• Scar Anteriorly
• Fibula To Be Divided Before Tibia At A Higher Level
AMPUTATION IN LEG

18. Krukenberg’s Amputation
Done In Trauma
Forearm Amputation
Gap B/W Radius And Ulna Like A Claw
AMPUTATION IN UPPER LIMB

19. • Fo re q u a r te r Amputation
• Inter Scapulo Thoracic Amputation
• Upper Limb With Scapula, Lateral 2/3 Of
Clavicle
• Indication - malignancy involving axial
skeleton (sarcoma)
AMPUTATION IN UPPER LIMB

20. POST OPERATIVE PERIOD
•
•
•
Regular dressings are done
Physiotherapy is started as early as possible
Pt uses crutches for walking, Prosthesis is
fitted after 3 months
• Rehablitation is started

21. COMPLICATIONS
• Later
• Pain
• Infection, bone spur, scar
adherent to bone,
amputation neuroma
• Phantom limb
• Phantom pain
• Ulceration of the stump
• pressure effects of the
prosthesis/↑ ischemia.
• Early
 Hemorrhage,
Hematoma,
Infection
 Gas gangrene
 Wound dehiscene
 Gangrene of flaps
 DVT → Pulm.
Embolism

22. REFERENCES
• Bailey & Love's Short
Practice of Surgery, 27th
Edition: International
Student's Edition. Pg 1144.
• Manipal Manual of Surgery
4th Edition; K Rajgopal,
Anitha Shenoy. Pg 700-704