جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/ افضل استشاري عظام في الاردن / عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور / خلع الولادة / تركيب المفاصل الاصطناعيه للركبه والورك / اوجاع العظام / افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور / مستشار جراحة عظام الأطفال. ============================================== البروفيسور فريح عوده أبوحسان Freih Odeh Abuhassan M.D, F.R.C.S (Eng.), F.R.C.S (Orth. & Tr.) London, Professor of Orthopaedic Surgery, Professor of Paediatric Orthopaedic Surgery, Senior Consultant Orthopaedic Surgeon, Expert Orthopaedic Surgeon & Spine Surgeon, Expert Pediatric Orthopaedic Surgeon, Pioneer in Ilizarov technique for limb reconstruction. Professor Orthopaedic Center, The Istishari Hospital - Amman. Vice President of the Arab Board Scientific Council in Orthopaedic Surgery. Center Tel: +9626 593 1956 Mobile:+962 79 556 58 63 - +962 77 779 27 97 www.prof-abuhassan.com professor_center@hotmail.com eacademic.ju.edu.jo/freih

1. 11/7/2014
Professor Freih Abuhassan -
University of Jordan
1

2. Freih Odeh Abu Hassan,
F.R.C.S(Eng),F.R.C.S(Tr.& Orth.)
Professor of Orthopedics
University of Jordan -Amman
Professor Freih Abuhassan -
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University of Jordan

3. The skin is closed over the end
of the stump
Professor Freih Abuhassan -
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University of Jordan

4. (except in PVD)
* Highly desirable, makes the amputation
easier in Tourniquet with exsanguination.
* In infections or malignancy, inflation
of the tourniquet should be preceded
by elevation of the limb for 5 minutes.
Professor Freih Abuhassan -
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University of Jordan

5. * Use defined flaps electively with the
apex of the fish mouth at the level
of the bony resection.
* Use any available flaps in trauma to
preserve length.
Covering the stump with good skin is
of the utmost importance
Professor Freih Abuhassan -
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University of Jordan

6. Professor Freih Abuhassan -
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University of Jordan

7. The scar
Should not be adherent to the underlying
bone because an adherent scar makes
prosthetic fitting extremely difficult and
because this type of scar often breaks
down after prolonged prosthetic use.
Professor Freih Abuhassan -
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University of Jordan

8. Equal ant + post
Equal med + lat
Long post - PVD
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University of Jordan

9. * Divide ~5 cm distal to level of bone resection
* Bevelling or contouring may be required
for good stump shape
*The conical shape is no longer necessary and is
even undesirable in fitting modern prosthetic
sockets.
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University of Jordan

10. 1. Provides stump padding
2. Prevents atrophy
3. Improves function
4. Prevents bursa formation
5. these techniques improve the
function of the muscles and the
circulation in the stump and help
prevent phantom pain
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University of Jordan

11. suture of flexors to the
extensors over bony stump
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University of Jordan

12. Direct suture of muscle to bone.
most useful in AK, AE and
disarticulations
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University of Jordan

13. Myodesis
Contraindicated in PVD
or ischemia from other causes
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University of Jordan

14. * Divide cleanly under gentle tension
proximal to bone ends  allow to retract
*Large nerves e.g Sciatic - ligate due to large
contained vessels
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University of Jordan

15. Professor Freih Abuhassan -
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University of Jordan

16. * Large A&V should be doubly ligated
*Haemostasis prior to closure.
The tourniquet should be released and
all bleeding points should be clamped
and ligated or coagulated
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University of Jordan

17. * Avoid excessive periosteal stripping
(prevent spur formation)
* Chamfer appropriately by raspe
to form a smooth contour
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University of Jordan

18. Professor Freih Abuhassan -
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University of Jordan

19. * Do not close under tension
* Use interrupted sutures
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University of Jordan

20. The drains or tubes are removed
48 - 72 hr after surgery.
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University of Jordan

21. An open amputation is one in which the
skin is not closed over the end of the
stump.
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University of Jordan

22. 1- Open amputations with inverted
skin flaps.
The wound is allowed to drain freely
and is usually ready to close secondarily
within 10 to14 days without shortening
the stump.
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University of Jordan

23. Professor Freih Abuhassan -
University of Jordan
11/7/2014 23

24. 2-Circular open amputations.
* Healing of a circular open amputation
is quite prolonged and depends on the
use of constant skin traction that tends
to pull all of the soft tissues over the end
of the stump.
* Most often a stellate or convoluted scar
results that can be difficult to manage
prosthetically
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University of Jordan

25. 1- A soft dressing program
or the rigid dressing concept.
2- Compression but not proximaly
3- with or without early prosthetic
ambulation.
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University of Jordan

26. *Wrapping of stump with extreme caution
hastens its healing, shrinkage, &
maturation
* Crutches when limb control achieved.
* Usually the wound is dressed and
the drains are removed at 48 hours.
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University of Jordan

27. * the sutures are removed at 10 to 14 days
* Definitive prosthesis at ~ 3 wks when
stump stabilised
Except when the patient is bathing, the stump
is kept snugly wrapped with an elastic bandage
until the prosthesis is fitted. Then the bandage
is used at night until the stump is mature.
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University of Jordan

28. Professor Freih Abuhassan -
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University of Jordan

29. Employs POP cast applied to the stump in
the OR at the conclusion of surgery
1- Prevents edema at the surgical site
= enhances wound healing
= early maturation of the stump
2- Decrease P.O pain, allow earlier
resumption of the erect posture
and ambulation with support
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University of Jordan

30. 3- The hospital stay can be decreased and
the cost of care reduced accordingly
4-There is earlier fitting with a definitive
prosthesis and a documented higher
percentage of patients who are
successfully rehabilitated.
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University of Jordan

31. The rigid dressing should be removed and
the surgical wound inspected in 7- 10 days.
Use of the rigid dressing is continued until
definitive prosthetic fitting, which is usually
possible at 4 - 8 weeks after surgery.
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University of Jordan

32. Options
1. Immediate
2. Prompt - ~7-10 days when evidence of
stump healing
3. Early - ~ 3 wks after stump has healed
4. Late - after stump is fully mature and
little chance of stump breakdown
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University of Jordan

33. Immediate postsurgical prosthesis fitted to below-elbow
amputation for trauma. Appearance on 13th postoperative day.
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University of Jordan

34. Immediate postsurgical prosthesis for the above-knee amputation
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University of Jordan

35. Immediate postsurgical prosthesis for the below-knee amputation.
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University of Jordan

36. Immediate postsurgical prosthesis for the hip-disarticulation
amputation
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University of Jordan

37. Immediate postsurgical prosthesis for the Syme amputation.
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University of Jordan

38. Immediate postsurgical prosthesis in knee disarticulation
for congenital anomalies.
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University of Jordan

39. 1- Age, strength, and agility of the patient.
2- Patient’s ability to protect the amputation
stump from injury as a result of excessive
weight-bearing.
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University of Jordan

40. 3- Availability of a well-trained team of
nurses,therapists, and prosthetists who
can consistently carry out a well-integrated
prosthetic treatment program;
4- The desire and willingness of the surgeon
to meticulously supervise such a treatment
program.
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University of Jordan

41. early unprotected weight-bearing can result
in sloughing of the skin or delayed healing
of the wound,
any weight-bearing ambulation allowed before
the wound has healed be strictly supervised
and that the stump be protected by the use
of crutches or a walker until the wound
has healed.
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University of Jordan

42. * Prone lying in AKA
* Muscle setting exercises followed by
exercises to mobilize the joints
* With BKA the patient is cautioned against
hanging the stump over the edge of the
bed or resting on crutch or lying or sitting
for a long time with the knee flexed.
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University of Jordan

43. Rehabilitation is not complete until
the patient has been fitted with
an appropriate prosthesis and
sufficiently trained in its use
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University of Jordan

44. Professor Freih Abuhassan -
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University of Jordan