AMPUTATIONS

INDICATIONS
 DEAD

 DEADLY

 DEAD LOSS
 DEAD
Gangrene
large vessel
– Atherosclerosis
– embolus
small vessel
– Diabetes
– Buerger,s disease
– Raynaud,s disease
 DEADLY
 moist gangrene with surrounding
putrefaction and infection

 spreading cellulitis

 neoplasm (osteogenic sarcoma)

 AV fistula
 DEAD LOSS
 severe trauma

 severe contracture or paralysis

 severe rest pain

 TYPES OF AMPUTATIONS
 MINOR
– Ray
– Trans-metatarsal
 MAJOR

CONE BEARING END BEARING

Below knee Gritti-Stokes

Above knee Through knee
Syme,s
MINOR AMPUTATION

 RAY AMPUTATION
– excision of phalanges with head of
metatarsal
– tendons are cut back
– wound left open
– Commonly done for diabetic foot
 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 ankle joint
• Above knee 12.5 cm above the knee joint
– Stump with gentle rounded contour
– Adequate muscle padding over the bone
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.
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.
 Vessels in nerves ligated
 Fibula divided 2 cm proximal to tibia
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
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
 Hemostasis secured
 Bone covered with muscles
 Suction drain placed
 Wound closed with interrupted
stitches
 Pressure dressing done
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 relief with opiates

 care of good limb

 exercises and mobilization

 Use of artificial limb

COMPLICATIONS
 EARLY
– Reactionary haemorrhage
– Hematoma formation
– Abscess formation
– Gas gangrene
– Wound dehiscense
– Gangrene of flaps
– DVT and pulmonary embolism
COMPLICATIONS
 LATE
– unresolved infection (sinus, osteitis,
sequestrum)
– bone spur
– amputation neuroma
– phantom limb
– Phantom pain
– ulceration of stump