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AMPUTATIONS-ppt.pptx

AMPUTATIONS-ppt.pptx

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Principles of Amputations
Principles of Amputations

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Published by: Muhammad Azhar Qureshi on Jun 12, 2013
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07/25/2015

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AMPUTATIONS

Dr. M. AZHAR QURESHI
Consultant General Surgeon
KKMC HOSPITAL

DEFINITION • Removal of the whole or part of an arm/hand or a leg/foot • Amputations can occur after an injury (traumatic amputation) or deliberately at surgery .

WHY TO AMPUTATE ?? “A useful and painless artificial limb is better than a painful and non functional natural limb” 4 .

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

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

GENERAL PRINCIPLES OF AMPUTATIONS • Treat the cause if possible and try to save the limb • 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 7 .

PREPARATION • Prophylactic antibiotics • Clean the limb and seal off infected or necrotic area • Arrange for disposal of limbs • Clearly mark the affected limb 8 .

5.OPERATIVE PROCEDURE 1. 6. 3. 4. 2. Flaps Division of skin and muscles Nerves Blood vessels Bone Closure 9 .

STUMP LENGTH • In 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 prosthesis • In an above knee amputation a 25 to 30 cm stump is optimum 10 .

11 .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.

Fore quarter amputation 2.) 1.UPPER LIMB AMPUTATIONS (Contd. Shoulder disarticulation 12 .

End bearing : pressure born at the end of the amputated limb Cone bearing : pressure born elsewhere proximal to the amputated cite (by prosthesis) 13 .LOWER LIMB AMPUTATIONS 1. 2.

LOWER LIMB AMPUTATIONS RAY AMPUTATIONS 14 .

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

PIROGOFF’S AMPUTATION Pre-Operative Post Operative 16 .

the plantar soft tissues being preserved to make the flap 17 .CHOPART'S AMPUTATION • Amputation of the foot at the midtarsal joint.

LISFRANC-AMPUTATION • Amputation of the foot between the metatarsus and tarsus. 18 .

BELOW KNEE AMPUTATION 19 .

GRITTI-STOKES AMPUTATION 20 .

ABOVE KNEE AMPUTATION 21 .

22 .HINDQUARTER AMPUTATION • An operation involving removal of an entire leg and part or all of the pelvis associated with it.

COMPLICATIONS • Hematoma • Infection • Flap necroses • Joint contracture • Neuromas • Phantom limb • Phantom pain 23 .

24 .

CONCLUSION • Always try to treat the cause in order to avoid amputation • If inevitable then don’t delay it • Always consult experts in artificial limb centers for maximum benefit 25 .

Thank You 26 .

QUESTIONS ?? 27 .

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