AMPUTATIONS

Dr. VARUN NARULA

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”

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INCIDENCE

tumors infections Neurologica

3% 2% l/
congenital
trauma 3%
10%

vascular/
diabetes
83%
 INDICATIONS

● Three main groups:

a. Dead : Due to arterial occlusive disease causing gangrene

b. Deadly : This is seen in moist gangrene when putrefaction and

infection spreads to involve adjacent healthy tissues.

c. Dead Loss: When due to relentless ischemic pain, paralysis, 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

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PREPARATION

● Prophylactic antibiotics

● Clean the limb and seal off infected or necrotic area

● Arrange for disposal of limbs

● Clearly mark the affected limb

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OPERATIVE PROCEDURE

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

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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

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 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.

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 UPPER LIMB AMPUTATIONS (Contd.)

1. Fore quarter amputation

2. Shoulder disarticulation

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LOWER LIMB AMPUTATIONS

1. End bearing : pressure born at the end of the

amputated limb
2. Cone bearing : pressure born elsewhere
proximal to the amputated cite (by prosthesis)

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LOWER LIMB AMPUTATIONS
RAY AMPUTATIONS

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

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PIROGOFF’S AMPUTATION

Pre-Operative Post Operative

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 CHOPART'S AMPUTATION
● Amputation of the foot at the midtarsal joint, the
plantar soft tissues being preserved to make the flap

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

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BELOW KNEE AMPUTATION

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GRITTI-STOKES AMPUTATION

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ABOVE KNEE AMPUTATION

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 HINDQUARTER AMPUTATION

• An operation involving removal of an entire leg and

part or all of the pelvis associated with it.

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COMPLICATIONS

● Hematoma
● Infection
● Flap necroses
● Joint contracture
● Neuromas
● Phantom limb
● Phantom pain

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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

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Thank You

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