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.
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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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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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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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
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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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.
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
Amputation of a limb is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss.
Phantom pain-- massage , cold packs, exercise and neuromuscular stimulation
-TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis