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

INCIDENCE

trauma 10% vascular/ diabetes 83%

tumors 3%

infections 1%

Other 4%

Neurological/ congenital 3%

INDICATIONS

a. b.

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.

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

OPERATIVE PROCEDURE
1. 2. 3. 4. 5. 6. Flaps Division of skin and muscles Nerves Blood vessels Bone 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. 2. End bearing : pressure born at the end of the amputated limb 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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PIROGOFFS 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 dont delay it Always consult experts in artificial limb centers for maximum benefit

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Thank You

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QUESTIONS ??

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