AMPUTATIONS

INDICATIONS 
DEAD  DEADLY  DEAD

LOSS

s disease ± Raynaud.DEAD Gangrene large vessel ± Atherosclerosis ± embolus small vessel ± Diabetes ± Buerger.s disease .

DEADLY  moist gangrene with surrounding putrefaction and infection spreading cellulitis neoplasm (osteogenic sarcoma) AV fistula    .

DEAD LOSS  severe  severe  severe trauma contracture or paralysis rest pain .

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s .TYPES OF AMPUTATIONS  MINOR ± Ray ± Trans-metatarsal  MAJOR BEARING END CONE BEARING Below knee Above knee Gritti-Stokes Through knee Syme.

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MINOR AMPUTATION  RAY AMPUTATION ± excision of phalanges with head of metatarsal ± tendons are cut back ± wound left open ± Commonly done for diabetic foot .

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MAJOR AMPUTATION Preoperative preparation       Informed consent Improvement of general condition of the patient Physiotherapy Antibiotics Analgesia Assessment of joints .

Choice of operation  Cone bearing ± Stump should be of sufficient length ‡ ( below knee 10-12cm) ‡ (above knee > 20 cm) ± Stump must not be too long ‡ Below knee7.5 cm above the knee joint ± Stump with gentle rounded contour ± Adequate muscle padding over the bone .5 cm above the ankle joint ‡ Above knee 12.

Below Knee Amputation 2 types: ± Long posterior flap ± Skew flap  RULE: length of flap must be at least one and a half times the diameter of the leg at the point of bone section. .

 Vessels in nerves ligated  Fibula divided 2 cm proximal to tibia .Below Knee Amputation LONG POSTERIOR FLAP:  Incision deepened to bone anteriorly  Bulk of gastrocnemiuas left with flap laterally and posteriorly  Blood vessels identified and ligated  Nerves transected as high as possible.

Below Knee Amputation  Tibia divided at desired level  Wound washed with N/S  Boner covered with muscles of posterior flap  Suction drain placed  Interrupted skin sutures applied  Pressure dressing done .

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Above Knee Amputation  Curved equal ant. and post. flaps made  Skin and muscles are divided in same line  Vessels are ligated  Sciatic nerve ligated and cut high  Bone is divided .

Above Knee Amputation secured  Bone covered with muscles  Suction drain placed  Wound closed with interrupted stitches  Pressure dressing done  Hemostasis .

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End Bearing Amputations     Rarely performed now Gritti-Stokes amputation: trans-condylar Through knee amputation: less complex Syme¶s amputation: ± Preserves blood supply of heel flap ± Dissection of calcaneum done ± Tibia and fibula divided as low as possible .

Syme¶s Amputation .

POST OPERATIVE CARE  pain  care relief with opiates of good limb and mobilization  exercises  Use of artificial limb .

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COMPLICATIONS  EARLY ± Reactionary haemorrhage ± Hematoma formation ± Abscess formation ± Gas gangrene ± Wound dehiscense ± Gangrene of flaps ± DVT and pulmonary embolism .

sequestrum) ± bone spur ± amputation neuroma ± phantom limb ± Phantom pain ± ulceration of stump . osteitis.COMPLICATIONS  LATE ± unresolved infection (sinus.