This document discusses amputations, including definitions, incidence rates, indications, levels, procedures, complications, and prognosis. Some key points: - Amputations remove all or part of a limb. They can be primary, without attempting limb salvage, or secondary, after a failed salvage attempt. - Most amputations are due to vascular/diabetes issues (83%) or trauma (10%). Lower limbs are more commonly affected than upper limbs. - Indications are often related to issues of ischemia, infection, or non-functionality of the limb. - Level and length of the amputation are based on tests of blood flow and functionality. Proper preparation, technique, and post-

2. AMPUTATIONS
Dr. M. AZHAR QURESHI
Consultant General Surgeon
KKMC HOSPITAL

3. DEFINITION
Removal of the whole or part of an arm/hand or leg/foot
• Primary Amputation.
Amputation performed without an attempt at
limb salvage.
• Secondary Amputation.
Amputation performed following a failed
attempt at limb salvage.
• Traumatic amputation.
Amputation occurring at the time of injury.

4. INCIDENCE
vascular/
diabetes
83%
trauma
10%
tumors
3%
infections
1%
Neurological/
congenital
3%
Other
4%

5. INCIDENCE
(contd..)
Age
Non Traumatic-common in 50-75 yrs of age
Traumatic- common in young age
Sex
Approx. 75% male
25% female
Limb
Approx. 85% - lower limb
15% -- upper limb

6. INDICATIONS
3 ‘Ds’
• Three main groups:
a. Dead : Due to arterial occlusive disease causing gangrene
b. Deadly : This is seen in moist gangrene when putrefaction and
infection spreads to involve adjacent healthy tissues.
c. Dead Loss: When due to relentless ischemic pain, paralysis, trauma or
deformity the limb can not be used or it hinders its normal
function

7. GENERAL PRINCIPLES OF
AMPUTATIONS
• Treat the cause if possible and try to save the limb
• The patient should be given time to come to terms with
inevitability of amputation and then get informed consent.
• Discuss the level with experts in regional limb fitting center
• General anesthesia is preferable
• Try to preserve joints
• Try to preserve epiphysis in children
• For tumors confirm the diagnosis with tissue biopsy
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8. LEVEL OF AMPUTATION
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Certain tests are designed to measure the blood flow which
help in deciding the exact level of amputation. They are:
1. Doppler Studies,DSA,MRA,CT angiography of the limb.
2. Xenon 133 studies. It uses radiopharmaceutical material.
3. Transcutaneous Oxygen ( TcPO2 ) mapping with oxygen
electrode
4. Laser Doppler measurements of the microcirculation of skin
5. Skin Fluorescent Studies to measure skin microcirculation
6. Skin perfusion measurements with BP cuff & photoelectric
detector
7. Infrared measurements of skin temperature

9. STUMP LENGTH
• In the upper arm and fore arm a 20 cm stump is
recommended
• In an above knee amputation a 25 to 30 cm
stump is optimum
• For lower leg a 14 cm tibial stump is ideal
• A stump a less than 8 cm below knee and 20 cm
above is difficult to secure in a prosthesis
• Stump should not be too long to hinder the
mobility of artificial joint
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10. PREPARATION
• Prophylactic antibiotics
• Clean the limb and seal off infected or necrotic area
• Arrange for disposal of amputated limb according
to religious and cultural customs
• Clearly mark the affected limb
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11. OPERATIVE PROCEDURE
1. Flaps
2. Division of skin and muscles
3. Nerves
4. Blood vessels
5. Bone
6. Closure
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12. UPPER LIMB AMPUTATIONS
• Fingers
• Hands
• Arm and Fore arm
• Krukenberg amputation:
The Krukenberg procedure also known
as the Krukenberg operation is a surgical
technique that converts a forearm
stump into a pincer.
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13. UPPER LIMB AMPUTATIONS (Contd.)
1. Fore quarter amputation
2. Shoulder disarticulation
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14. LOWER LIMB AMPUTATIONS
1. End bearing : pressure born at the end of the
amputated limb
a. Through knee
b. Gritti Stokes
c. Syme’s Amputation
2. Cone bearing : pressure born elsewhere
proximal to the amputated cite (by prosthesis)
a. Above Knee amputation
b. Below knee amputation
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15. LOWER LIMB AMPUTATIONS
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RAY AMPUTATIONS

16. TRANSMETATARSAL-
AMPUTATION
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17. LISFRANC-AMPUTATION
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• Amputation of the foot between the metatarsus and tarsus.

18. CHOPART'S AMPUTATION
• Amputation of the foot at the midtarsal joint, the
plantar soft tissues being preserved to make the flap
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19. PIROGOFF’S AMPUTATION
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Pre-Operative Post Operative

20. SYME-AMPUTATION
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• Disarticulation of the foot with removal of both malleoli.

21. BELOW KNEE AMPUTATION
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22. GRITTI-STOKES AMPUTATION
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23. ABOVE KNEE AMPUTATION
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24. HINDQUARTER AMPUTATION
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• An operation involving removal of an entire leg and
part or all of the pelvis associated with it.

25. GOALS OF POST OP
MANAGEMENT
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Prompt, uncomplicated wound healing
Control of edema
Control of Postoperative pain
Prevention of joint contractures
Rapid rehabilitation

26. RISK FACTORS
• Diabetes & other co-morbidities
• Poor Blood Supply
• Malnutrition & Anemia
• Immuno-compromised states
• Clotting disorders
• Pre-existing infection
• Obesity
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27. COMPLICATIONS
General
• DVT & Cardio-vascular accidents
• Atelectasis and pneumonia
• New onset renal failure
• Psychological
Local
• Bleeding / Hematoma
• Flap Necrosis
• Neuromas
• Joint contracture
• Phantom limb / Phantom Pain
• Infection
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28. VACUUM ASSISTED DRESSING
(VAC)
First described by Fleischmann et al in 1993,
Vacuum Assisted Closure (also called vacuum
therapy, vacuum sealing or topical negative pressure
therapy) is a sophisticated development for chronic,
discharging non-healing wound.
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29. 29

30. PERI- OPERATIVE MORTALITY
AKA - 16.5 %
BKA - 5.7 %
CARDIOVASCULAR 45.7 %
SEPSIS 14.3 %
PNEUMONIA 11.4%
GI PERFORATION 2.85%
PULMONARY EMBOLISM 2.85 %
STROKE 2.85 %
MOF 17.1%
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31. 31
PROGNOSIS
(AKA Vs BKA)

32. 32
PROGNOSIS
(Renal Dysfunction)

33. 33
PROGNOSIS
(Diabetes)

34. CONCLUSION
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• Always try to treat the cause in order to avoid
amputation
• If inevitable then don’t delay it
• With proper rehabilitation and well fitted prosthesis
patient can lead a normal life.

35. Thank You
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36. QUESTIONS ??
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