amputation

AmputationAmputationDr. Abdullah-Al-Mamun

‘‘DDD’DDD’• DeadDead

• DeadlyDeadly

• Dam Nuisance Dam Nuisance

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Indications:Indications:

• Derived from the Latin amputare. • "to cut away", from ambi- ("about", "around") and putare ("to

prune").

• Amputation is the complete removal of an injured or deformed body part.

• The English word "amputation" was first applied to surgery in the 17th century.

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Nomenclature.Nomenclature.

HistoryHistory

• Most ancient of surgical procedure.Most ancient of surgical procedure.

• Historically were stimulated by the aftermath of war.Historically were stimulated by the aftermath of war.

• It was a crude procedure by which limb was rapidly severed from It was a crude procedure by which limb was rapidly severed from unanesthetized patient.unanesthetized patient.

• The open stamp was then crushed or dipped in boiling oil to obtain The open stamp was then crushed or dipped in boiling oil to obtain hemostasis.hemostasis.

• Hippocrates was the first to use ligature.Hippocrates was the first to use ligature.

• Ambroise Pare ( a France military surgeon) introduced artery forceps. Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis.He also designed prosthesis.

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EtiologyEtiology

TraumaTrauma

BurnsBurns

Peripheral Vascular DiseasePeripheral Vascular Disease

Malignant TumorsMalignant Tumors

Neurologic ConditionsNeurologic Conditions

InfectionsInfections

Congenital DeformitiesCongenital Deformities

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TraumaTrauma

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Malignant TumorMalignant Tumor

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GangreneGangrene

CrushCrush

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Peripheral Vascular DiseasePeripheral Vascular Disease

Polydactyly

Congenial AnomalyCongenial Anomaly

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SclerodermaScleroderma

Determination of levelDetermination of level

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• Zone of Injury (trauma)Zone of Injury (trauma)• Adequate margins (tumor)Adequate margins (tumor)• Adequate circulation (vascular disease)Adequate circulation (vascular disease)• Soft tissue envelopeSoft tissue envelope• Bone and joint conditionBone and joint condition• Control of infectionControl of infection• Nutritional statusNutritional status

• Debridement of all Nonviable tissue and foreign materialDebridement of all Nonviable tissue and foreign material

• Several debridements may be requiredSeveral debridements may be required

• Primary wound closure often contraindicatedPrimary wound closure often contraindicated

• High voltage, electrical burn injuries require careful High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present evaluation because necrosis of deep muscle may be present while superficial muscles can remain viablewhile superficial muscles can remain viable

TechniquesTechniques

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• NerveNerve• Prevent neuroma formationPrevent neuroma formation• Draw nerve distally, section it, allow it to retract Draw nerve distally, section it, allow it to retract

proximallyproximally

• SkinSkin• Opportunistic flapsOpportunistic flaps• Rotation flapsRotation flaps• Tension freeTension free• Skin graftsSkin grafts

TechniquesTechniques

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• Bone:Bone:

• Choose appropriate levelChoose appropriate level• Smooth edges of boneSmooth edges of bone• Narrow metaphyseal flare for some disarticulationsNarrow metaphyseal flare for some disarticulations

• Postoperative Dressing:Postoperative Dressing:• SoftSoft• RigidRigid

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TechniquesTechniques

• Goals of Postoperative ManagementGoals of Postoperative Management

• Prompt, uncomplicated wound healingPrompt, uncomplicated wound healing

• Control of edemaControl of edema

• Control of Postoperative painControl of Postoperative pain

• Prevention of joint contracturesPrevention of joint contractures

• Rapid rehabilitationRapid rehabilitation

TechniquesTechniques

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Techniques… Techniques… Few examplesFew examples

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Techniques… Techniques… Few examplesFew examples

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After 12 months

Techniques… Techniques… Few examplesFew examples

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• Goals of Postoperative ManagementGoals of Postoperative Management

• Prompt, uncomplicated wound healingPrompt, uncomplicated wound healing

• Control of edemaControl of edema

• Control of Postoperative painControl of Postoperative pain

• Prevention of joint contracturesPrevention of joint contractures

• Rapid rehabilitationRapid rehabilitation

TechniquesTechniques

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Rehabilitation and ProstheticsRehabilitation and Prosthetics

• Goals of Postoperative ManagementGoals of Postoperative Management

• Prompt, uncomplicated wound healingPrompt, uncomplicated wound healing

• Control of edemaControl of edema

• Control of Postoperative painControl of Postoperative pain

• Prevention of joint contracturesPrevention of joint contractures

• Rapid rehabilitationRapid rehabilitation

TechniquesTechniques

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Rehabilitations.Rehabilitations.

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• 1. Residual Limb Shrinkage and Shaping1. Residual Limb Shrinkage and Shaping• 2. Limb Desensitization2. Limb Desensitization• 3. Maintain joint range of motion3. Maintain joint range of motion• 4. Strengthen residual limb4. Strengthen residual limb• 5. Maximize Self reliance5. Maximize Self reliance• 6. Patient education: Future goals and prosthetic options6. Patient education: Future goals and prosthetic options

Psychological stress.Psychological stress.

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• Up to 2/3 of amputees will manifest postoperative Up to 2/3 of amputees will manifest postoperative psychiatric symptomspsychiatric symptoms

• DepressionDepression• AnxietyAnxiety• Crying spellsCrying spells• InsomniaInsomnia• Loss of appetiteLoss of appetite• Suicidal ideationSuicidal ideation

ProstheticsProsthetics

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PassivePassive

CosmeticCosmetic

Body PoweredBody Powered

Harnesses and cablesHarnesses and cables

MyoelectricMyoelectric

Surface EMGSurface EMG

Activation delayActivation delay

NeuroprostheticsNeuroprosthetics

InvestigationalInvestigational

Management of AmputeeManagement of Amputee

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• PreparationPreparation• Good Surgical TechniqueGood Surgical Technique• RehabilitationRehabilitation• Early Prosthetic FittingEarly Prosthetic Fitting• Team ApproachTeam Approach• Vocational and Activity RehabilitationVocational and Activity Rehabilitation