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Is the removal of limb or appendage from the body Removal of the limb through a joint is termed disartculation

Percentage of (N)
Below-elbow 0-35 35-55 55-90 90-100

Classification
Very short, below elbow Short below elbow Long below elbow Wrist disarticulation

Percentage of (N)
Above - elbow 0 1-30

Classification
Shoulder disarticulation Humeral neck

31-50
51-90 91-100

Short above elbow


Standard or long above elbow Elbow disarticulation

Level

Stump
Proximal Ref Pt Distal Ref Pt Distal end of stump Distal end of stump Bony end of stump Bony end of stump

Normal
Proximal Ref Pt Medial tibial plateau Medial inguinal line Tip of acromion process Medial epicondyle Distal Ref Pt Medial malleolus Medial tibial plateau Lateral epicondyle Ulnar styloid process

BKA AKA

Medial tibial plateau Inner or medial inguinal line Tip of acromion process Medial epicondyle

AEA

BEA

The ratio of stump length of the (N) leg is obtained by dividing the length of the stump with the length of the normal side Ex: length of amputated leg = 25 cm Length of (N) limb = 50 cm Stump length = 25/50 = 50% In bilateral amputees, upper length is estimated by multiplying the pxs height with a fixed factor .19. to estimate forearm length, the pxs height is again multiplied by a fixed factor .21

Main cause of amputation in the lower extremity is PVD, especially associated with smoking and DM Next leading cause of amputation in the LE is trauma, such as gunshot wound or motor vehicle accident. This is followed by malignant tumor, infections and limb discrepancies Main cause of amputation in the UE for all age group is trauma followed by congenital deficiency From birth to 10 years of age, congenital followed by acquired are the leading causes of amputation. For the young adults, trauma and for older people, PVD

Hip hindquarter amputation removal of half of pelvis through the sacroiliac joint and symphysis pubis Hip disarticulation pelvis is retained and is closed with a gluteal flap Hemipelectomy resection of the lower half of the pelvis Hemicorporectomy amputation of both limbs and pelvis below L4, L5 level

Knee disarticulation removal of the lower limb is done through the knee joint with the cruciate ligaments being preserved with the menisci are removed. Has 3 advantages: a. large end bearing surface of the distal femur covered by skin and other soft tissue is preserved and is naturally suited for weight bearing b. Have a long lever arm c. Prosthesis used on the stump is stable

Gritti-Stokes Amputation femoral condyles are cut at or about the adductor tubercle and the roughened patella is opposed to the distal end of the cut femur and held there by suture. This results in a weight bearing stump which can withstand excessive strain. This is also reserved for traumatic cases since this type of amputation is difficult to perform in px with vascular disease Callendar (long above Knee) amputation formed at the level of the adductor tubercle and is usually done in cases where the knee itself cannot be preserved. The patella is removed and myoplasty is done. Best for patients with circulatory problems

Closed Amputation Long posterior flap (burgess technique) Equal anterior and posterior flaps (fishmouth) Equal medial and lateral (sagittal) flaps Skew flaps End weight bearing amputations Osteomyoplasty Erti procedure Open amputations Guillotine Open circumferential Open flaps

Boyd forward shift of calcaneus with calcaneotibial arthrodesis plus talectomy; excision of all tarsals except calcaneus Piragoff vertical sectioning of the calcaneus; arthrodesis of the posterior part of calcaneus and tibia Symes best amputation between transmetatarsal level and the middle third of leg Most satisfactory functional level of amputation in LE Removal of calcaneus with attachment of heel pad to distal end of tibia May include removal of malleoli and distal fibular flares

Sarmiento (modified Syme) Amputation transection of the tibia and the fibula approximately 1.3 cm proximal to the ankle joint and excision of the medial and lateral malleoli Vas Conecelos Amputation employed when the use of an artificial limb is not anticipated; midtarsal amputation combined with tibiotalar and subtalar arthrodesis and section of the inferior surface of the calcaneus

Lisfrancs amputation thru tarsometatarsal joint; the most proximal that allows any function of the foot Choparts amputation thru the midtarsal joint; severe equinovalgus deformity may develop; all bones of the foot are removed except the calcaneus (os calcis) and talus (astragulus)

No dog ears usually caused by improper bandaging Intact sensation No tenderness No phantom pain No open wound No LOM No contracture Good to normal MMT Cylindrical shaped and fish mouth flap if below knee Cone shaped and posterior flap if above knee

Fibular head; hamstrings Anterodistal end of the stump Tibial tubercle, crest and distal tibia

Patellar tendon; pretibial mm Popliteal area; gastroc-soleus; medial tibial flare

BKA
AKA BKA & AKA Bilateral BKA Crutch without prosthesis Wheelchair Bilateral AKA

10-40%
65% 75% 41% 60% 9% 110%

The long posterior flap (Burgess technique) is preferable for dysvascular BK amputation because the mm padding in the long posterior flap facilitates true total contact fitting. The anterior and posterior flaps meet in a small half circle that eliminates the dog ear