AMPUTATION: Cutting of the extremity or part of the extremity through the bone
While ………..
DISARTICULATION: Cutting of the extremity or part of the extremity through the joint
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Presentation on different levels of amputation of upper limb including hand amputations., thumb reconstructions, kruckenberg amputation, thumb poloicization.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Presentation on different levels of amputation of upper limb including hand amputations., thumb reconstructions, kruckenberg amputation, thumb poloicization.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Amputation is of the common surgical procedure done in the ER. This is also common in various routine cases. This presentation covers various aspects of amputation including steps of below knee amputation. The background has been changed from the previous one to hide the brutality of this procedure.
Guidelines on the use of plaster of paris in fracture management. Quite useful for orthopedic residents, GPs, plaster techs, orthopedic care nurses, rehabilitation physicians, physiotherapists
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Amputation is of the common surgical procedure done in the ER. This is also common in various routine cases. This presentation covers various aspects of amputation including steps of below knee amputation. The background has been changed from the previous one to hide the brutality of this procedure.
Guidelines on the use of plaster of paris in fracture management. Quite useful for orthopedic residents, GPs, plaster techs, orthopedic care nurses, rehabilitation physicians, physiotherapists
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
Outcome of Mitchell's procedure in the treatment of hallux valgusAbdulla Kamal
Presentation of my thesis in IBFMS committee under supervision of pro. Dr. Omer Barawi.
Hallux valgus is a complex deformity of medial ray that often coexist with deformities and symptoms within the other toes.
commonest foot and all musculoskeletal deformities.
worldwide prevalence = 23% (18- 65 years) 35% > 65 years
Onset (46% up to 92%) before skeletal maturation
Female predominance up to 90%
Bilateral HV up to 84%
Shoulder examination frequently appears in OSCEs.Shoulder complaints are fairly common presentations to Accident and Emergency, general practice, and orthopaedic clinics. The examination of all joints follows the general pattern of “look, feel, move” as well as occasionally special tests, in which this station has many.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
The menisci are crescents, roughly triangular in cross section, that cover one half to two thirds of the articular surface of the corresponding tibial plateau. They are composed of dense, tightly woven collagen fibers arranged in a pattern providing great elasticity and ability to withstand compression.
A fingertip injury is defined as any soft tissue, nail or bony injury distal to the dorsal and volar skin creases at the distal interphalangeal joint and insertions of long flexor and extensor tendons of a finger or thumb.
The fingertips are exposed to all aspects of daily living,
recreation and work and it is perhaps no surprise they
are the most commonly injured part of the hand
Bone physiology and calcium homeostasisAbdulla Kamal
Bone is a highly specialized supporting framework of the body, characterized by its rigidity, hardness, and power of regeneration and repair.
It protects the vital organs, provides an environment for marrow ,acts as a mineral reservoir for calcium homeostasis and a reservoir of growth factors and cytokines, and also takes part in acid–base balance.
Bone constantly undergoes modeling (reshaping) during life to help it adapt to changing biomechanical forces, as well as remodeling to remove old, micro-damaged bone and replace it with new, mechanically stronger bone to help preserve bone strength.
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Lower limb neurological examination frequently appears in OSCEs. You’ll be expected to pick up the relevant clinical signs using your examination skills. This lower limb neurological examination OSCE guide provides a clear, concise, step-by-step approach to performing a neurological examination of the lower limb
The exact anatomy of the bones and joints is of great importance to the clinician when examining the limbs and to the surgeon when operating on the bones and joints.
To understand deformities of the extremities, it is important to first understand and establish the parameters and limits of normal alignment.
Each long bone has a mechanical and an anatomic axis
both frontal and sagittal planes axis lines are applicable to any longitudinal projection of a bone.
The corresponding radiographic projections are the anteroposterior (AP) and lateral (LAT) views, respectively.
Hallux rigidus:
A condition characterized by loss of motion of first MTP joint in adults due to degenerative arthritis
second most common condition affecting the big toe after hallux valgus
most common arthritic condition in the foot.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
The term ‘cerebral palsy’ includes a group of disorders that result from permanent non-progressive brain damage during early development and are characterized by abnormalities of movement and posture.
Also Known As…
Nargile
Argile (Lebanon, Syria)
Hubble Bubble (Saudi Arabia, United Arab
Emirates)
Shisha (Egypt, Morocco)
.............
History of the Hookah
- Originated in India, made from a coconut shell
- Arrived in Turkey about 500 years ago.
Became popular with intellectuals and upper class.
Grew in size and complexity, similar to hookahs
seen today.
- Gained popularity and quickly spread to Iran and
the rest of the Arab world
......................
Height below 3rd centile or less than 2
standard deviations below the median
height for that age & sex according to
the population standard.
Or
Even if the height is within the normal percentiles but growth velocity is consistently below 25th percentile over 6-12 months of observation
Differences between the lengths of the upper and/or lower arms and the upper and/or lower legs.
Except in extreme cases, arm length differences cause little
or no problem in how the arms function.
Arthrocentesis: A bedside procedure in which a sterile needle and syringe are used to drain fluid from the joint, and in some conditions, medication is injected into the joint after fluid removal.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. *AMPUTATION: Cutting of the extremity or part of
the extremity through the bone
While ………..
*DISARTICULATION: Cutting of the extremity or
part of the extremity through the joint
3. *Amputation surgery is an ancient procedure dating back to
prehistoric time.
*The word amputation is derived from the Latin amputare, "to
cut away“.
*The English word "amputation" was first applied to surgery in
the 17th century by Peter Lowe in 1612.
*amputation of the hands, feet or other body parts is or was
used as a form of punishment for people who committed
crimes.
* In some cultures and religions, minor amputations are
considered as a ritual accomplishment.
4. *Cave-wall hand imprints have been found which
demonstrate that Neolithic humans had amputated
limbs.
*Earliest literature discussing amputation is the
Babylonian code of Hammurabi 1700 BC
*385 BC – Plato's symposium and Hippocrates De Articularis
*1st century BC – cautery was used for large vessels
*1588 – William Clove – first successful AKA
*1674 – Morel – battle of Borodino – tourniquet
*1679 – Younge – local flaps for wound closure (animal bladder
used previously)
5. *1781 – John Warren – 1st successful shoulder amputation
*1806 – Walter Brashear –1st successful hip joint amputation
*1825 – Nathan Smith – described knee disarticulation
*1870 – Stockes and Grittis procedure
*1890 – Jaboulay and Girard – 1st successful hindquarter
amputation
*1943 – Norman Kirk – guillotine procedure in WWII
6. *In US 30,000 – 40,000 amputation are performed
annually.
*There were 1.6 million individuals living with
loss of a limb in 2005. These expected to become
3.6 million by the year 2050
*Male : female ratio LE = 2:1
UE = 4:1
*majority in the 65 - 79 year age group
* LE : UE ratio = 11:1
*10% perioperative mortality
*3 year survival after BKA – 57%; after AKA – 39%
9. 1. Peripheral vascular disease ( 60 -70 % in LE )
DM (90%)
Arteriosclerosis
Thromboembolism
2. Severe traumatized limb ( 75 – 80 % in UE)
3. Burns
4. Frostbite
1D Dead or dying limb
10. 1. Malignant tumors
2. Lethal sepsis
3. Crush injury leading to crush syndrome
2D Dangerous limb:
11. Remaining the limb is more worse than having no
limb at all …. Because of :-
1. Pain
2. Gross malformation
3. Recurrent sepsis
4. Severe loss of function
3D Damn nuisance
12. When primary healing is unlikely
The limb amputate as distal as the causal factor will
allow
Skin flap suture loosely over a pack
Re-amputation perform when stump condition is
favorable
Provisional amputation
13. When weight is taken through the end of the stump
The scar must not be terminal
Bone end must be solid (cut near the joint)
Definitive end-bearing
14. Commonest variety
All upper limb & most lower limb amputations are
come under this type
The scar can be terminal
Definitive non-end-bearing
15. *Wagner et al (Journal of vascular surgery 1988):
[ clinical judgment is superior to objective
assessments. More distal amputations can
be achieved with clinical measures over objective
studies.]
*Clinical judgment is central to
amputation level selection.
16. oskin quality, extent of ischemia/ infection
opresence of a pulse immediately above the level
of amputation – almost 100% chance of healing
ojoint- and residual-limb-length salvage is directly
correlated with functional outcome
oShort stump slips out from the prosthesis
oLong stump pain, ulceration, incorporate of
the joint in the prosthesis
oNow a day the skill of prosthetist make
amputation possible at any level
Subjective measures
Clinical examination
Local function
Prosthetic design
18. oDoppler ultrasound pressures
maybe unreliable in diabetics
ankle pressures >60mm
--->50% chance of BKA healing
oSkin perfusion pressures
Radio isotope washout
Laser doppler velocimetry
<20mm Hg – 89% failure of healing
19. otranscutaneous oximetry
Tested under local hyperthermia
Correlates with true PaO2
Threshold value – 30mm
oInvasive – Angiographic scoring
Poor correlation
20. 1. Interscapulo-thoracic (fore-quarter) amputation.
oTraumatic avulsion of the upper limb
oeradicating a malignant tumour
o aspalliation for intractable sepsis or pain.
2. Disarticulation of the shoulder
oRare event
3. transhumeral (above-elbow)amputations
o the appearance is much better
oshortest arm stump is 2.5 cm
4. Elbow disarticulation
Upper limb amputations:
21. 5. Transradial (forearm) amputation
ooptimal length is at the junction of the middle and
distal thirds of the forearm
oBoth bones cut in same level
6. Wrist disarticulation
7. Amputations in the hand
oPolydactyly
oTraumatic amputation of fingers
Upper limb amputations:
22. 1. Hemipelvectomy (hindquarter amputation)
operformed only for malignant disease.
2. Disarticulation of the hip joint
oprosthetic fitting is difficult
3. Transfemoral amputation
oat least 12 cm
4. knee disarticulation &( Gritti-Stokes amp.)
oassociated with poorer functional and psychological
outcomes
omain indication is in children
5. Transtibial (below knee) amputation
oEven a 5–6 cm(optimum 12cm) stump may be fitted with
a prosthesis
oHave a good function and nearly normal gait
Lower limb amputations:
23. 1. Ankle disarticulation (Syme’s amputation)
ogives excellent function in children
obones are divided just above the malleoli
2. & 3. Pirogoff’s and Boyd’s amputation
oSimilar in principle to Syme’s
oThe part of calcaneus is fixed onto the cut end of
the tibia and fibula.
Partial foot amputations
4. Mid-tarsal joint ( chopart amputation )
5. Tarsometatarsal joint ( lisfranc amputation)
6. Transmetatarsal
7. Metatarsophlangeal
8. Transphalangeal
Lower limb amputations:
24. * Tourniquet is used unless there is vascular
insufficiency
* Skin flaps are cut so that there combined
length equals 1.5 the width of the limb at the site of
the amputation.
* Muscle cut at distal level from the level of the bone
proposed. Osteomyodesis is done when the opposing
muscle groups sutured together over the bone ends.
25. *Nerves are divided proximal to the bone cut
*Saw is used to make the bone ends smooth ,
and for beveling the tibia interiorly
oFibula is cut 3 cm shorter
*The main vessels are meticulously ligated.
*Remove the tourniquet and stop bleeding Suture the
skin without tension Apply suction drain Bandage
the stump tightly
26. *Skin flaps should be of full thickness
*Periosteal stripping should be sufficient
*Stable residual limb muscle mass can improve function by
reducing atrophy and providing a stable soft tissue envelope
over the end of the bone.
*The nerve end should come to lie deep in a soft tissue
envelope, away from potential pressure
areas.
*Rigid dressings (postoperative) help reduce
swelling, decrease pain, and protect the stump
from trauma.
*Early prosthetic fitting is done within 5 to 21
days after surgery in selected patients.
35. *Guillotine amputation is used in emergency situations
for contaminated wounds or infection.
*Skin, muscle and bone are divided at the same
level.
*All bleeding vessels are tied and nerves are cut
sharply while under gentle tension, allowing them to
retract into the wound.
*Debridement and lavage of the wound are done every
2–5 days until it is free of dead tissue and infection. At
that point, definitive amputation and closure are
performed.
36. *The metabolic cost of walking is increased with proximal-
level amputations and is inversely proportional to the
length of the residual limb and the number of functional
joints preserved.
*The higher the level of amputation ,the higher the oxygen
consumption
• BKA –10-40% increase in energy expenditure
• AKA –50-70% extra energy expenditure
37. ocomplications of any operation (bleeding, pain,
infection, complications of anesthesia,…)
oBreakdown of skin flaps (may be due to ischemia
or excessive suture tension )
oGas gangrene (especially AKA)
EARLY COMPLICATIONS:
38. oSkin; Eczema, tender purulent lumps in groin.
Ulceration due to poor circulation.
oMuscle; unstable ‘cushion’ stump If too much muscle is
left
oBlood supply; Poor circulation gives a cold, blue stump
that is liable to ulcerate.
oPhantom limb; feeling that all or part of the amputated
limb is still present
oPhantom pain is a burning, painful sensation in the part
having undergone amputation.
LATE COMPLICATIONS:
39. oNerve; A cut nerve always forms a neuroma and
occasionally this is painful and tender.
oJoint; The joint above an amputation may be stiff
or deformed.
oBone; A spur often forms at the end of the bone, but is
usually painless. Bones that not used may becomes
osteoporotic and liable to fracture.
LATE COMPLICATIONS:
40. (Gitter and Bosker 2005):[Yet with appropriate
rehabilitation, many people can learn to walk or
function again and live high quality lives.]
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
Rehabilitation
42. *Amputation represents loss of
function, sensation and body image.
*(Gitter and Bosker 2005):[Limb loss
is one of the most physically and
psychologically devastating events
that can happen to a person. Not
only does lower limb amputation
cause major disfigurement, it
renders people less mobile and at
risk for loss of independence.]
43. *Up to 2/3 of amputees will manifest postoperative
psychiatric symptoms:
Depression
Anxiety
Crying spells
Insomnia
Loss of appetite
Suicidal ideation
45. • Solomon L., Warwick D. , Nayagam S.,[2010] Apley’s System of Orthopaedics and Fractures, 9th ed.
Hodderarnold comp.,London, UK.
• Miller M. , Thompson S. , Hart J. ,[2012] REVIEW OF ORTHOPAEDICS [PDF], 6th ed. by Saunders, an
imprint of Elsevier Inc. , Philadelphia, USA.
• Canale S. , Beaty J. , [2007] Campbell’s Operative Orthopaedics [PDF], 11th ed. By Mosby, An
Imprint of Elsevier , Tennessee, USA.
• Matthew L., HMO2, [2011] Amputation and Limb Prostheses [PPT]. http://www.authorstream.com/
heier.barb-1256551-amputation2012..ppt (accessed nov. 22, 2011)
• Arvind Lee , [2014] Lower Limb Amputations – Level Selection [PPT]. http://www.austpar.com/
portals/lowerlimbamputationlevelselection.ppt (accessed dec.2003)
• Kovryha M. F., [2010] Basic Surgical Principles of Amputations and Disarticulations of the Upper and
Lower Extremities [PPT]. http://www.slideshare.net/ xatcon/amputation-3286795.ppt.
• Andrew H. Schmidt, David Ring, [2011] Upper Extremity Amputation [PPT].http://www.aota.org/
media/34684/U13_UE_Amputations-tfh-edited.ppt (accessed Feb. 2011)
• Yousaf S., Kieffer W. [ 2013] Management of traumatic amputations at BSUH [PPT]. Brighton and
Sussex medical school . Brighton, UK.
• Der Eingriff . [2000] AMPUTATIONS & PROSTHETICS [E-Book].http://www.thieme.de/amputation/
0000015919440/amputation_prothetics.pdf
• M. Jason Highsmith, [2006] Epidemiology & Statistics associated with Limb Loss & Limb Deficiency
[E-Book]. South Florida , USA. http://www.ncbi.nih.gov/pubmed/21140687/ Epidemiology -
Statistics .pdf
• Wikimedia Foundation, http://www.en.wikipedia.org/wiki/Amputation (last modified Nov, 2015)