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amputation orthopedics mbbs with types.pptx
- 2. Nomenclature. • 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. Amputation
- 3. 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
- 4. Condition leading to amputation Trauma Burns PeripheralVascular Disease MalignantTumors Neurologic Conditions Infections Congenital Deformities 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
- 15. • 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
- 16. • 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
- 17. • Bone: • Choose appropriate level • Smooth edges of bone • Narrow metaphyseal flare for some disarticulations • Postoperative Dressing: • Soft • Rigid Amputation Techniques
- 18. • Goals of Postoperative Management • Prompt, uncomplicated wound healing • Control of edema • Control of Postoperative pain • Prevention of joint contractures • Rapid rehabilitation Techniques Amputation
- 20. • A tourniquet, Unless there is a arterial insufficiency. • Skin Flaps: Combined length must be 1.5X width. • Muscles are divided distal to the proposed site of bone section. • Myodesis: opposing groups are sutured over the bone end to each other and with the periosteum. • Osteomyodesis: Anchoring opposing muscles group with the bone trough drill hole and sutures. Principles of techniques
- 21. • Nerve are divided proximal to the bone cut to ensure nerve end do not bear weight. • Tibia is swan across the proposed level and front of the tibia is usually beveled and filed to create a smooth rounded contour. • Fibula is cut 3 cm shorter. • The main vessels are tied. • The tourniquet is removed and every bleeding point meticulously ligated. • The skin is sutured carefully without tension. • Suction drain is advised. • Soft figure of eight bandage is given. Principles of techniques…
- 22. BK Amputations: Post operative follow up after 14 days Amputation
- 25. After 12 months Techniques… Few examples Amputation
- 27. Rehabilitations. Amputation • 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
- 28. Psychological stress. Amputation • Up to 2/3 of amputees will manifest postoperative psychiatric symptoms • Depression • Anxiety • Crying spells • Insomnia • Loss of appetite • Suicidal ideation
- 29. Prosthetics Amputation Passive Cosmetic Body Powered Harnesses and cables Myoelectric Surface EMG Activation delay Neuroprosthetics Investigational
- 30. Management of Amputee Amputation • Preparation • Good SurgicalTechnique • Rehabilitation • Early Prosthetic Fitting • Team Approach • Vocational and Activity Rehabilitation