1. AMPUTATIONS
A GENERAL OVERVIEW

2. • INTRODUCTION
• INDICATIONS
• TYPES
• LEVELS OF AMPUTATION
• BASIC PRINCIPLES
• AFTER TREATMENT
• COMPLICATIONS

3. INTRODUCTION
• DEFN-REMOVAL OF THE DISEASED,NON
FUNCTIONING,PROTRUDING BODY PART
• DERIVED FROM LATIN WORD “AMPUTARE”
MEANING ‘CUTTING AROUND’
• INCIDENCE:AGE-50-75 YRS
SEX-MALES[75%]
LIMBS-LOWER LIMB[85%]

4. INDICATIONS
• POOR CIRCULATION -POVD, DIABETES
• INJURY
TRAUMA-3/5 STRUCTURES GROSSLY AND
IRRIVERSIBLY INJURED
FROST BITE,BURNS
• INFECTIONS
FULMINANT GAS GANGRENE,C/C
OSTEOMYELITIS,INFECTED NON UNIONS,C/C
INFECTED TROPHIC ULCER

5. • TUMOURS
NOWADAYS DECREASED BECAUSE OF
SEVERAL LIMB SALVAGE TECHNIQUES
• CONGENITAL ANOMALIES
most common indication in children

6. TYPES
• CLOSED AMPUTATIONS
FLAPS ARE FASHIONED AND ARE CLOSED PRIMARILY
ALONG WITH SURGERY.
• OPEN AMPUTATIONS
FLAPS ARE NOT CLOSED PRIMARILY
LATER REVISED AMPUTATION, REAMPUTATION OR
PLASTIC REPAIR
1.GUILLOTINE TECHNIQUE
ALL THE TISSUES ARE CUT AT THE SAME LEVEL.IN
SEVERE CRUSH INJURIES AND SEVERE INFECTIONS.

7. • CIRCULAR AMPUTATION
WITH FLAPS RETAINED FOR LATER
DELAYED SUTURING.
OTHER TYPES
• REVISION AMPUTATION-for ideal stump
• REAMPUTATION

8. • EARLY AMPUTATION
SO GROSS THAT THERE IS NO
ALTERNATIVE
• INTERMEDIATE AMPUTATION
AFTER TEMPORARILY SALVAGING THE LIMBS
DEGREE OF DAMAGE JUSTIFY EARLY
AMPUTATION
• LATE AMPUTATION
PAINFUL SYMPTOMATIC MALUNION OR NON
UNION

9. LEVELS OF AMPUTATIONS
• HIGHER THE LEVEL OF AMPUTATION GREATER IS
THE DIFF TO RESTORE ABILITY
• AMPUTATION STUMP SHOULD BE LONG
ENOUGH
• IF A JOINT IS ARTHRODESED,SECTION AT JOINT
LEVEL OR ABOVE
• POVD-LEVEL SHOULD BE BELOW THE DISTAL
MOST ARTERIAL PULSATION
• IN ELDERLY FRAIL-BK AMPUTATION
• OTHERWISE KNEE DISARTICULATION

10. • IN CLINICAL PRACTICE
COLOUR AND TEMP OF THE SKIN BEFORE
SURGERY
APPEARANCE OF FREE CAPILLARY BLEEDING
FROM CUT SURFACES ON OPERATION

11. UPPER LIMB
• SHOULDER DISARTICULATION
• SHORT ABOVE ELBOW
• STANDARD ABOVE ELBOW
• LOW ABOVE ELBOW
• ELBOW DISARTICULATION
• SHORT BELOW ELBOW
• MEDIUM BELOW ELBOW
• LONG BELOW ELBOW
• WRIST DISARTICULATION

12. LOWER LIMB AMPUTATIONS

13. BASIC PRINCIPLES
• ANAESTHESIA-GA OR SAB
• TOURNIQUET
CONTRA INDICATED IN ISCHAEMIC LIMB AND
ATHEROSCLEROSIS
EXSANGUINATION PRIOR TO TOURNIQUET
APPLICATION-CONTRA INDICATED IN INFECTED
LIMBS AND MALIGNANCIES
• SKIN FLAPS-GOOD
COVERAGE,MOBILE,ADEQUATE LENGTH

14. • MUSCLES
SECTIONED 5 CM DISTAL TO BONY SECTION
1.MYODESIS-SUTURING TO BONE
(CI-ISCHAEMIC LIMB)
2.MYOPLASTY-OPPOSING MUSCLES ARE
SUTURED
ADVANTAGES-
• SHAPE OF THE STUMP GOOD

15. • INSULATE CUT NERVE ENDINGS
• MUSCLES ORIGINATING PROXIMALLY
PROVIDE GOOD LEVERAGE
• PHANTOM PAIN MAY BE PREVENTED
• PREVENT RETRACTION &PAINFUL MUSCLE
CONTRACTION

16. • BLOOD VESSELS
DOUBLE LIGATION AND CUT
• NERVES
PULLED AND CUT SO THAT IT RETRACTS INTO THE
STUMP
• BONES
PERIOSTEAL STRIPPING MINIMISED
• DRAIN
48-72 HRS

17. AFTER PROGRAMME
• DRESSINGS
1.RIGID DRESSING-POP CAST
DECREASED STUMP EDEMA,EARLY
HEALING,LESS POST OP PAIN,TEMPORARY
PROSTHETIC FITTING
2.SOFT DRESSING-SOFT BANDAGES AND
ELASTOCREPE BANDAGES

18. REHABILITATION
• BEGIN ASAP
• GOALS –REDUCE EDEMA, INCREASE
STRENGTH, PREVENT CONTRACTURES,
MAXIMISE FUNCTIONAL INDEPENDENCE.
• BALANCE & COORDINATION ACTIVITIES FOR
GAIT TRAINING.
• WALKING AIDS
• ALSO VOCATIONAL TRAINING, PAIN MNGMT,
PSYCHO EDUCATION.

19. COMPLICATIONS
• HAEMATOMA
• INFECTIONS
• NECROSIS
• CONTRACTURES
• PAINFUL NEUROMAS
• PHANTOM LIMB
PREVENTED BY TREATMENT OF NERVES AT
THE SURGERY,MYOPLASTIC PROCEDURES AND
PROPER STUMP BANDAGING AND STUMP
EXERCISES.

20. STUMP
• IDEAL LENGTH
• IDEAL SHAPE
• MUSCULAR
• GOOD POWER OF MUSCLES
• NO FIXED DEFORMITY
• FULL AND FREE MOVTS OF JOINT ABOVE
• INFN FREE
• NON ADHERENT INCISION SCAR
• ABSENCE OF NEUROMA

21. CAN BE ACHIEVED BY
• STUMP DRAINAGE
• STUMP SPLINTING
• STUMP BANDAGING
• STUMP EXERCISES EARLY
• STUMP HYGEINE

22. SYME’S AMPUTATION
ANKLE DISARTICULATION,REMOVAL OF
MALLEOLI AND ANCHORING HEEL PAD TO THE
WEIGHT BEARING AREA

23. • TWO POINTS 1.75 CM BELOW LAT
MALLEOLUS AND 2.5 CM BELOW MED
MALLEOLUS ARE JOINED INFRONT OF THE
ANKLE AND ALSO VERTICALLY ACROSS THE
HEEL PAD

24. • ANT INCISION DEEPENED-TALUS AND
CALCANEUM REMOVED LEAVING ALL SOFT
TISSUE IN THE FLAP
• MEDIAL AND LATERAL MALLEOLI ALONG
WITH A THIN SLICE OF TIBIA REMOVED
• DON’T TRIM ‘’DOG EARS’’
• ADV-PATIENT CAN WALK WITHOUT A
PROSTHESIS

25. LIS FRANCS AMPUTATION
• AMPUTATION THROUGH MIDDLE OF THE
FOOT
• SEVERE EQUINUS DEFORMITY
FRICTION IN ANTERO POSTERIOR PRT OF
STUMP

26. CHOPARTS AMPUTATION
• AMPUTATION THROUGH MID TARSAL JOINT
• SUBTALAR FUSION AND ELONGATON OF
TENDO ACHILLES
• DISCARDED BCOZ OF SAME REASON

27. PIGROFF’S AMPUTATION
• ANT PART OF CALCANEUM IS CUT ACROSS
AND RAW BONE IS FIXED TO THE RAW
UNDERSURFACE OF TIBIA
• CALCANEAL TUBEROSITY -WEIGHT BEARING
AREA

28. BOYD’S AMPUTATION
• TALUS IS EXCISED
• CALCANEUM IS ADVANCED AND ATTACHED
TO THE RAW UNDERSURFACE OF TIBIA
• STABLE LOAD BEARING SURFACE

29. THANK YOU