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1 AMPUTATIONS

Dr. M. AZHAR QURESHI Consultant General Surgeon KKMC HOSPITAL

DEFINITIONRemoval of the whole or part of an arm/hand or a leg/footAmputations can occur after an injury (traumatic amputation) or deliberately at surgery3WHY TO AMPUTATE ??4A useful and painless artificial limb is better than a painful and non functional natural limb INCIDENCEINDICATIONSThree main groups:Dead : Due to arterial occlusive disease causing gangrene Deadly : This is seen in moist gangrene when putrefaction and infection spreads to involve adjacent healthy tissues.Dead Loss: When due to relentless ischemic pain, paralysis, trauma or deformity the limb can not be used or it hinders its normal functionGENERAL PRINCIPLES OF AMPUTATIONS Treat the cause if possible and try to save the limb Get informed consentDiscuss the level with experts in regional limb fitting center General anesthesia is preferable Try to preserve joints Try to preserve epiphysis in childrenFor tumors confirm the diagnosis with tissue biopsy

7PREPARATION Prophylactic antibiotics Clean the limb and seal off infected or necrotic areaArrange for disposal of limbs Clearly mark the affected limb

8OPERATIVE PROCEDUREFlaps Division of skin and musclesNervesBlood vesselsBoneClosure

9STUMP LENGTHIn the upper arm and fore arm a 20 cm stump is recommended For lower leg a 14 cm tibial stump is ideal A stump a less than 8 cm is difficult to secure in a prosthesisIn an above knee amputation a 25 to 30 cm stump is optimum

10UPPER LIMB AMPUTATIONSFingersHandsArm 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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UPPER LIMB AMPUTATIONS (Contd.)Fore quarter amputationShoulder disarticulation12

LOWER LIMB AMPUTATIONSEnd bearing : pressure born at the end of the amputated limb

2. Cone bearing : pressure born elsewhere proximal to the amputated cite (by prosthesis) 13LOWER LIMB AMPUTATIONS 14

RAY AMPUTATIONSSYME-AMPUTATION15Disarticulation of the foot with removal of both malleoli.

PIROGOFFS AMPUTATION16

Pre-OperativePost OperativeCHOPART'S AMPUTATIONAmputation of the foot at the midtarsal joint, the plantar soft tissues being preserved to make the flap17

LISFRANC-AMPUTATION18Amputation of the foot between the metatarsus and tarsus.

BELOW KNEE AMPUTATION19

GRITTI-STOKES AMPUTATION20

ABOVE KNEE AMPUTATION21

HINDQUARTER AMPUTATION

22An operation involving removal of an entire leg and part or all of the pelvis associated with it.COMPLICATIONSHematoma InfectionFlap necrosesJoint contracture Neuromas Phantom limbPhantom pain

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CONCLUSION25Always try to treat the cause in order to avoid amputationIf inevitable then dont delay it Always consult experts in artificial limb centers for maximum benefit

Thank You26QUESTIONS ??2727