different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis

1. LOWER LIMB
AMPUTATION
DR. PRATIK AGARWAL

2. DEFINITION
AMPUTATION-
SURGICAL ABLATION OF
BODY PART THROUGH ONE
OR TWO BONE.
DISARTICULATION-
SURGICAL ABLATION OF
BODY PART THROUGH JOINT.

3. INDICATION
OF
AMPUTATION
:• PERIPHERAL VASCULAR
DISEASE
• TRAUMA
• BURNS
• FROSTBITE
• INFECTION
• TUMORS
• NEUROPATHY
• CONGENITAL LIMB
DEFICIENCY

4. SALVAGIBILITY OF A LIMB
VARIOUS SCORING SYSTEM-
• PREDICTIVE SALVAGE INDEX
• LIMB SALVAGE INDEX
• LIMB INJURY SCORE
• MANGLED EXTREMITY SEVERITY
SCORE

5. SCORE<6- SALVAGEABLE; SCORE>7- HIGHLY PREDICTIVE OF

6. BASIC
PRINCLIPLES OF
AMPUTATION
TOURNIQUET USE:
EXCEPT FOR IN
ISCHEMIC LIMB, USE OF
TOURNIQUET IS
DESIRABLE AND MAKES
AMPUTATION EASIER.

7. MYOPLASTY
• TRANSECTED MUSCLE IS
SUTURED TO SOFT TISSUE
SUCH ASOPPOSING MUSCLE
GROUP OR FASCIA.
• PREFERRED IN YOUNG AND
ISCHEMIC LIMB WHERE
MYODESIS IS
CONTRAINDICATED.

8. MYODESIS
• TRANSECTED MUSCLE
GROUPS ARE SUTURED TO
BONE UNDER PHYSIOLOGIC
TENSION.
• MYODESIS SHOULD BE
PERFORMED TO PROVIDE
STRONGER INSERTION,
MAXIMIZE STRENGTH AND
MINIMIZE ATROPHY.

9. NERVES
TO PREVENT FORMATION
OF NEUROMA NERVE IS
CUT BY KNIFE AFTER
PULLING IT GENTLY
DISTALLY, AND
ALLOWING AT TO
RETRACT ABOVE THE
SAW LINE.

10. PRE-OP CARE:
• NUTRITIONAL STATUS OF THE
PATIENT
• LIMB PERFUSION
• SERUM ALBUMIN OF ATLEST 3.5
G/DL
• TOTAL LYMPHOCYTE COUNT
>1500/ML
• HEMOGLOBIN >10 GM/DL
• DIABETES CONTROL
• PRE OPERATIVE COUNSELLING
• REHABILITATION ASSESSMENT

11. INTRA-OP
CARE:
• AVOID EXCESSIVE PRESSURE ON SKIN
EDGES.
• THICK SKIN FLAP.
• BONY PROMINENCES SHOULD BE
REMOVED.
• CONTROLLING HEMOSTASIS.
• CLOSURE SHOULD BE DONE
WITHOUT TENSION AT MARGIN.
• PRESERVE AS MUCH LENGTH IS
POSSIBLE.

12. POST-OP CARE:
• DRESSING LIKE HYDROCOLLOID,
HYDROGEL, ALGINATE ETC.
• BIOLOGICAL DRESSING LIKE
ALLOMATRIX AND GRAFTJACKET
REGENERATIVE TISSUE MATRIX.
• VACCUM ASSISTED CLOSURE IS ALSO
BENEFICIAL IN LARGER WOUND
• MEASURES TO PREVENT
CONTRACTURES
• TO MAXIMIZE FUNCTION AND MINIMIZE
COMPLICATION OF THE AMPUTED LIMB
PEDORTHIST, ORTHOTIST AND

13. GOALS OF
AMPUTATION:
• ABLATION OF DISEASE
TISSUE
• RECONSTRUCTION
• PROVIDE PHYSIOLOGICAL
END ORGAN
• OPTIMIZE PATIENT
FUNCTION AND REDUCE
MORBIDITY.

14. COMPLICATIO
NS
• HEMATOMA
• SKIN COMPLICATION
• BONY COMPLICATION
• WOUND NECROSIS
• STUMP OEDEMA
• CONTRACTURES
• NEUROMA
• PHANTOM LIMB
• PHANTOM PAIN
• MUSCLE WASTING
• PSYCHOLOGICAL PAIN

15. PHANTOM
PAIN
• SENSATION OF
PRESENCE OF
AMPUTATED PART.
• CAUSES:
UNABLATION OF
CORTICAL
REPRESENTATION.
• TENDS TO DISAPPEAR WALK ON MISSING

16. PHANTOM
PAIN
• PAINFUL, DISAGREEABLE
SENSATION WITH STRONG
PARESTHESIA IN ABSENT LIMB.
• CONSTANT OR INTERMITTENT.
• DESTRUCTION OF SENSORY FIBRES
RESULTING IN DECREASE
INHIBITORY CONTROL BY
RETICULAR ACTIVATING SYSTEM.
• SOMATOSENSORY PROJECTION
AREA DEVELOP SELF SUSTAINING
NEURAL ACTIVITY THUS CAUSING
PAIN.
• TREATMENT-
• EARLY USE OF PROSTHESIS
• DRUGS LIKE CARBAMAZEPINE, BETA
BLOCKERS, MORPHINE,
ANTIDEPRESSANT, PHENYTOIN,
AMITRIPTYLINE.
• SYMPATHECTOMY
• SUBCORTICAL NEURECTOMY,
• ANTEROLATERAL CORDOTOMY;
• ELECTRICAL STIMULATION OF
DORSAL COLUMN

17. TYPES OF LOWER
LIMB
AMPUTATION:
• HEMIPELVICTOMY
• HIP DISARTICULATION
• TRANSFEMORAL
AMPUTATION
• KNEE DISARTICULATION
• TRANSTIBIAL
AMPUTATION
• FOOT AMPUTATION

18. AMPUTATION OF FOOT:
 TOE AMPUTATION OR
DISARTICULATION
 METATARSAL PHALANGEAL
DISARTICULATION
 TRANSMETATARSAL
AMPUTATION
 LISFRANC AMPUTATION
 CHOPART AMPUTATION
 SYME AMPUTATION
 BOYD’S AMPUTATION

19. TOE AMPUTATION:
• AMPUTATION OF GRAET TOE:
 WHILE STANDING OR WALKING NORMALLY- FUNCTIONALLY
NO EFFECT.
 WHILE RUNNING- LIMP APPEARS.
• AMPUTATION OF 2ND TOE:
 CAUSES SEVERE HALLUX VALGUS. TO PREVENT SCREW
FIXATION IS USED.
• AMPUTATION OF ALL TOE:
 WHILE SLOW WALKING- LITTLE DISTURBANCE.
 WHILE RAPID GAIT- DISABLING.
 INTERFERES IN SQUATING AND TIPTOEING.
 NO PROSTHESIS IS REQUIRED OTHER THAN SHOE FILLER.

20. TERMINAL SYME
AMPUTATION:
• INDICATION: HALLUX TERMINAL
ULCERATION, CHRONIC INGROWN
NAILS WITH PARONYCHIA, HALLUX
TUFT OSTEOMYELITIS OR TRAUMATIC
INJURY TO TIP OF HALLUX.
• REMOVING DISTAL ASPECT OF DISTAL
PHALYNX OF HALLUX RETAINING
EXTENSOR HALLUCIS LONGUS AND
FLEXOR HALLUCIS LONGUS INSERTION.

21. AMPUTATION AT BASE
OF PROXIMAL PHALYNX

22. METATARSAL PHALANGEAL DISARTICULATION:
• LONG PLANTAR AND SHORT
DORSAL SKIN FLAP.
• FOR 1ST METATARSAL INCISION
STARTING MEDIALLY AND CURVE IT
DISTALLY OVER THE LATERAL AND
POSTERIOR ASPECT.
• FOR 5TH METATARSAL INCISION
STARTING LATERALLY AND CURVE
IT DISTALLY OVER MEDIAL AND
POSTERIOR ASPECT.

23. TRANSMETATARSAL
AMPUTATION:
• RAY AMPUTATION-
TOE AMPUTATION
WITH HEAD OF
METATARSAL.
• GILLIES’
AMPUTATION-
TRANSMETATARSAL
WITH PROXIMAL TO
NECK OF

24. PROSTHESIS FOR TOE AMPUTATION

25. MIDFOOT AMPUTATION
• AMPUTATION THROUGH
MIDFOOT INCLUDE
LISFRANC AMPUTATION AT
TARSOMETATARSAL JOINTS
AND CHOPART
AMPUTATION AT
TRANSVERSE TARSAL
JOINT.
• MIDFOOT AMPUTATION
LEAD TO SEVERE
EQUINOVARUS DEFORMITY.

26. LISFRANC AMPUTATION
• TARSOMETATARSAL
DISARTICULATION.
• LEAD TO SEVERE EQUINOVARUS
DEFORMITY. TO PREVENT
EQUINOVARUS DEFORMITY-
 PRESERVE INSERTION OF TIBIALIS
ANTERIOR AND PERONEUS LONGUS
AT MEDIAL CUNEIFORM AND
PERONEUS BREVIS AT THE BASE OF
5TH METATARSAL.
 BASE OF 2ND METATARSAL SHOULD

27. CHOPART
AMPUTATION:
• DISARTICULATION OF TALO-NAVICULAR
& CALCANEO-CUBOID JOINTS.
• TO PREVENT EQUINOVARUS DEFORMITY-
 ONE OR MORE DORSIFLEXORS MUST BE
TRANSFERRED.
 DECREASE STRENGTH OF ACHILLES
TENDON.
 POSITION THE STUMP IN SLIGHT
DORSIFLEXION AND RIGID DRESSING FOR 6
WEEKS.
 ALTERNATIVELY, ANKLE ARTHRODESIS
MAY BE DONE IMMEDIATELY.

28. CHOPART FRACTURE
• TRANSFER TIBIALIS ANTERIOR
TENDON TO LATERAL ASPECT OF
NECK OF TALUS, USING BONE
TUNNEL WITH BIOTENODESIS
SCREW AND USING A SUTURE
ANCHOR OR STAPLE TO SECURE
FIXATION.
• TRANSFER EXTENSOR HALLUCIS
LONGUS TO ANTERIOR PROCESS
OF CALCANEUS.

29. PROSTHESIS FOR CHOPART
AMPUTATION

30. HINDFOOT AND ANKLE AMPUTATION
• GOAL IS TO PRODUCE END
BEARING STUMP AND ENOUGH
SPACE BETWEEN END OF
STUMP AND GROUND FOR
CONSTRUCTION OF SOME
TYPE OF ANKLE JOINT
MECHANISM FOR ARTIFICIAL
FOOT.
• TYPES-
 SYME AMPUTATION
 BOYD AMPUTATION
 PIROGOFF AMPUTATION

31. SYME
AMPUTATION
• BONE TRANSECTION AT DISTAL TIBIA AND
FIBULA 0.6 CM PROXIMAL TO PERIPHERY OF
ANKLE JOINT AND PASSING THROUGH THE
DOME OF THE ANKLE CENTRALLY.
• THE TOUGH DURABLE SKIN OF HEEL FLAP
PROVIDES NORMAL WEIGHT BEARING SKIN.
• SARMIENTO MODIFIED SYME PROCEDURE BY
TRANSECTING TIBIA AND FIBULA 1.3 CM
PROXIMAL TO ANKLE JOINT AND EXCISION OF
MEDIAL AND LATERAL MALLEOLUS TO PRODUCE
LESS BULBOUS STUMP AND ALLOW USE OF MORE
COSMETIC PROSTHESIS.

32. SYME’S AMPUTATION
• CAN BE DONE IN-
1. ONE STAGE- ORIGINAL / CLASSIC SYME'S
AMPUTATION.
2. TWO STAGE- IN CASE OF GROSS
INFECTION OF FOREFOOT.
3. MODIFIED AMPUTATION- MODIFIED TO
GET A LESS BULBOUS AND MORE
COSMETIC STUMP BY REMOVING
METAPHYSEAL FLARE OF TIBIA AND
BEVELING DISTAL END OF FIBULA.

33. SYME’S AMPUTATION
SINGLE LONG POSTERIOR FLAP, BY BEGINING INCISION AT DISTAL TIP OF LATERAL
MALLEOLUS PASSING ACROSS ANTERIOR ASPECT OF ANKLE JOINT UPTO ONE FINGER
BREADTH INFERIOR TO MEDIAL MALLEOLUS, EXTENT IT DIRECTLY PLANTARWARD
ACROSS THE SOLE TO THE LATERAL ASPECT AND END IT AT STARTING POINT.
DIVIDE CAPSULE OF ANKLE JOINT. DIVIDE TENDO ACHILLES TENDON.
REMOVE THE ENTIRE FOOT. TRANSECT TIBIA AND FIBULA 0.6 CM PROXIMAL TO
THE JOINT LINE. HEEL PAD IS USED TO COVER THE STUMP.

34. SYME’S AMPUTATION

35. SYME’S AMPUTATION

36. SYME’S PROSTHESIS
• PROSTHESIS CONSIST OF MOLDED PLASTIC SOCKET WITH
REMOVABLE MEDIAL WINDOW TO ALLOW PASSAGE OF
BULBOUS END OF STUMP THROUGH ITS NARROW SHANK.

37. BOYD’S AMPUTAION
• TO PRODUCE EXCELLENT END BEARING STUMP AND
ELIMINATES THE PROBLEM OF POSTERIOR MIGRATION
OF THE HEEL PAD THAT OCCURS AFTER SYME
AMPUTATION.
• IT INVOLVES
 TALECTOMY,
 EXCISION OF ANTERIOR PART OF CALCANEUS, DISTAL TO
PERONEAL TUBERCLE.
 FORWARD SHIFT OF CALCANEUS AND CALCANEO-TIBIAL

38. PIRIGOFF AMPUTATION
• INVOLVES ARTHRODESIS
BETWEEN TIBIA AND PART
OF CALCANEUS.
• CALCANEUS IS SECTIONED
VERTICALLY, REMOVING
ANTERIOR PART AND
ROTATING POSTERIOR
PORTION WITH HEEL PAD
FORWARD AND UPWARD
90* TO MEET DENUDED
DISTAL END OF TIBIA.

39. TRANSTIBIAL
AMPUTATION
• MOST COMMON LOWER LIMB AMUTATION.
• ENERGY EXPENDITURE IS AN IMPORTANT
CONSIDERATION IN CHOOSING THE LEVEL OF
AMPUTATION.
• DEPENDING ON ISCHEMIC OR NON-ISCHEMIC
LIMB, LEVEL OF AMPUTATION, CHOICE OF SKIN
FLAP, STABILIZATION TECHNIQUES LIKE MYODESIS
OR MYOPLASTY AND POST OPERATIVE CARE
VARIES.
• IN CASE OF COMBAT INJURIES STANDARD FLAP
MAY BE IMPOSSIBLE. SKIN GRAFT MAY BE USED TO
COVER SOFT TISSUE DEFECT, BUT SKIN GRAFT ARE

40. VARIOUS DESIGN
OF SKIN FLAP:
 EQUAL ANTERIOR AND
POSTERIOR FLAP
 EQUAL MEDIAL AND
LATERAL FLAP
(SCANDINAVIAN FLAP).
 LONG POSTERIOR FLAP
(SKEWED FLAP).

41. IDEAL LENGTH
OF STUMP:
• IN BELOW KNEE AMPUTATION-
 IDEAL LENGTH 12.5 TO 17.5 CM DISTAL TO MEDIAL
TIBIAL ARTICULAR SURFACE.
 MINIMUM WORKING LENGTH -9 CM
 <12 CM LESS EFFICIENT
 <6 CM DO NOT FUNCTION
 RULE OF THUMB FOR SELECTING LEVEL OF BONE SECTION
IS TO ALLOW 2.5 CM OF BONE LENGTH FOR EACH 30 CM
OF BODY HEIGHT.

42. INTRA-OPERATIVE PRECAUTION WHILE
TAILORING AN IDEAL STUMP
• SKIN FLAP AS PER CAUSE.
• MUSCLE ARE DIVIDED 0.6 CM DISTAL TO LEVEL OF BONE SECTION.
• NERVES ARE DIVIDED CLEAN WITH KNIFE AFTER GENTLE TRACTION
AND ALLOW TO RETRACT PROXIMAL TO END OF STUMP.
• VESSELS ARE DOUBLY LIGATED JUST PROXIMAL TO THE LEVEL OF BONE
SECTION.
• BEVELLING OF TIBIA TO PREVENT SHARP END WHICH MIGHT IMPINGE

43. INTRA-OPERATIVE PRECAUTION WHILE
TAILORING AN IDEAL STUMP
• FIBULA SHOULD BE SECTIONED 1.2 CM PROXIMALLY.
• RELEASING THE TOURNIQUET AND ACHIEVING HEMOSTASIS
BEFORE CLOSURE.
• DRAIN TO KEPT IN-SITU.
• CLOSURE WITH NO TENSION AT MARGIN.
• IMMEDIATE POST OPERATIVE RIGID DRESSING SHOULD BE DONE.

44. TRANSTIBIAL AMPUTATION
NON-ISCHEMIC LIMB
• USE OF TOURNIQUET ADVOCATED.
• EQUAL ANTERIOR AND POSTERIOR
FLAP PREFFERED.
• LEVEL OF AMPUTATION- 12.5 TO
17.5 CM.
• MYOPLASTY IS COMMONLY DONE,
BUT IN YOUNG AGE GROUP MYODESIS
IS ADVOCATED.
ISCHEMIC LIMB
• REFRAINING FROM USE OF
TOURNIQUET.
• LONG POSTERIOR FLAP AND SHORT
ANTERIOR ONE IS PREFFERED.
• LEVEL OF AMPUTATION- 8.8 TO 12.5
CM.
• TENSION MYODESIS IS
CONTRAINDICATING BECAUSE IT
CAUSES FURTHER COMPROMISE IN

45. NON-ISCHEMIC LIMB

46. ISCHEMIC LIMB

47. POST OPERATIVE
CARE:
• IMMEDIATE POST OPERATIVE
RIGID DRESSING.
• CHANGE OF RIGID DRESSING
EVERY 5-7 DAYS.
• WEIGHT BEARING IS LIMITED
INITIALLY WITH SUPPORT.
• AFTER 3-4 WEEKS, RIGID
DRESSING CAN BE CHANGED
TO REMOVABLE TEMPORARY
PROSTHESIS IF NO SKIN
COMPLICATION.
• PROSTHESIS TO BE GIVEN
AFTER 2-3 MONTHS.

49. PROSTHESIS FOR TRANSTIBIAL AMPUTATION

50. PROSTHESIS FOR TRANSTIBIAL
AMPUTATION

51. KNEE
DISARTICULATION
• ADVANTAGE-
 RESULT IN EXCELLENT END BEARING STUMP.
 CREATION OF LONG LEVER ARM CONTROLLED BY
STRONG MUSCLES.
 STABILITY OF THE PROSTHESIS.
 KNEE FLEXION CONTRACTURES AND ASSOCIATED
DISTAL ULCER WITH TRANSTIBIAL AMPUTATION ARE
ALSO AVOIDED.
 IN NON-AMBULATORY PATIENT ADDITIONAL
EXTREMITY LENGTH PROVIDE ADEQUATE SUPPORT
AND BALANCE.
• BENEFIT IN CHILDREN AND YOUNG ADULTS, BUT

52. KNEE DISARTICULATION
BATCH, SPITTLER, AND MCFADDIN TECHNIQUE
FASHION LONG BROAD ANTERIOR FLAP FROM INFERIOR POLE OF PATELLA AND
SHORT POPLITEAL FLAP FROM POPLITEAL CREASE.
ANTERIOR FLAP ELEVATED INCLUDING INSERTION OF PATELLAR TENDON
AND PES ANSERINUS.
DIVIDE CRUCIATE LIGAMENTS AND POSTERIOR CAPSULE. DIVIDE TIBAIL NERVE
SLIGHTLY PROXIMALLY.
ATTEMPT TO FUSE PATELLA TO THE FEMORAL CONDYLE. PATELLAR TENDON
SUTURED TO CRUCIATE LIGAMENTS AND GASTROCNEMIUS MUSCLE.

53. BATCH, SPITTLER, AND MCFADDIN
TECHNIQUE

54. MAZET AND HENNESSY DISARTICULATION OF
KNEE
• DEBULKING STUMP BY
RESECTING PROTRUDING
MEDIAL, LATERAL AND
POSTERIOR SURFACES OF
FEMORAL CONDYLES FOR
WHICH IS MORE COSMETICALLY
ACCEPTABLE PROSTHESIS CAN
BE CONSTRUCTED.
• REQUIRES SMALLER SKIN FLAP,
WHICH MAY BE BENEFICIALFOR
WOUND HEALING IN ISCHEMIC
LIMB.

55. KJOBLE
DISARTICULATION OF
KNEE
• MEDIAL AND LATERAL SKIN FLAP.
• BETTER TECHNIQUE FOR HEALING
IN ISCHEMIC LIMB.

56. PROSTHESIS FOR KNEE
DISARTICULATION

57. TRANSFEMORAL
AMPUTATION:
• CAN BE CLASSIFIED AS
 SHORT TRANSFEMORAL
 MEDIAL TRANSFEMORAL
 LONG TRANSFEMORAL
 SUPRACONDYLAR AMPUTATION
• EXTREMELY IMPORTANT FOR THE
STUMP TO BE AS LONG AS POSSIBLE
TO PROVIDE A STRONG LEVER ARM
FOR CONTROL OF THE PROSTHESIS.

58. TRANSFEMORAL AMPUTATION
NON-ISCHEMIC LIMB
• USE OF TOURNIQUET ADVOCATED.
• EQUAL ANTERIOR AND POSTERIOR FLAP
PREFFERED.
• LEVEL OF AMPUTATION- 12 CM FROM
MEDIAL JOINT LINE OR 18 CM FROM
GREATER TROCHANTER TIP.
• MYOPLASTY IS COMMONLY DONE, BUT
IN YOUNG AGE GROUP MYODESIS IS
ADVOCATED.
ISCHEMIC LIMB
• REFRAINING FROM USE OF
TOURNIQUET.
• EQUAL ANTERIOR AND POSTERIOR FLAP
PREFFERED.
• LEVEL OF AMPUTATION- 12 CM FROM
MEDIAL JOINT LINE OR 18 CM FROM
GREATER TROCHANTER TIP.
• TENSION MYODESIS IS
CONTRAINDICATING BECAUSE IT
CAUSES FURTHER COMPROMISE IN
MARGINAL BLOOD SUPPLY.

59. TRANSFEMORAL AMPUTATION
FASHION EQUAL ANTERIOR AND POSTERIOR FLAP AT THE LEVEL OF
AMPUTATION.
MYOFASCIAL FLAP FASHIONED FROM QUADRICEPS MUSCLE AND
FASCIA.
ATTACHING ADDUCTOR AND HAMSTRING MUSCLETO END OF
FEMUR THROUGH DRILLED HOLE AND BRING QUADRICEP FASCIA
OVER END OF BONE AND SUTURE WITH POSTERIOR FASCIA.

60. TRANSFEMORAL AMPUTATION

61. GOTTSCHALK
TECHNIQUE:
• DIVIDE ADDUCTOR MAGNUS
FROM ADDUCTOR TUBERCLE
AND ATTACH ATTACH IT TO
LATERAL ASPECT OF DISTAL
ASPECT OF FEMUR USING
DRILLED HOLES KEEPING
FEMUR IN MAXIMUM
ADDUCTION.

62. PROSTHESIS FOR TRANSFEMORAL
AMPUTATION

63. PROSTHESIS FOR TRANSFEMORAL
AMPUTATION

64. HIP
DISARTICULATIO
N
• DFFERENT TECHINUES-
 ANATOMIC METHOD OF
BOYD HIP DISARTICULATION.
 POSTERIOR FLAP METHOD
OF SLOCUM.
• INGUINAL OR ILIAC LYMPH
NODE ARE NOT ROUTINELY
REMOVED.

65. HEMIPELVECTOMY
• IN CONTRAST TO HIP DISARTICULATION,
HEMIPELVECTOMY REMOVE INGUINAL
AND ILIAC LYMPH NODE.
• DIFFERENT TECHNIQUES:
 STANDARD HEMIPELVECTOMY
 EXTENDED HEMIPELVECTOMY
 CONSERVATIVE HEMIPELVECTOMY
• GORDON-TAYLOR CALLED HINDQUATER
AMPUTATION “ ONE OF THE MOST
COLLOSAL MUTILATIONS PRACTICED ON
HUMAN FRAME.”

66. HEMIPELVECTOMY
STANDARD
HEMIPELVECTOMY
EMPLOYS A POSTERIOR
OR GLUTEAL FLAP AN
DISARTICULATES THE
SYMPHYSIS PUBIS AND
SACROILIAC JOINT AND
THE IPSILATERAL LIMB.
CONSERVATIVE
HEMIPELVECTOMY
RESECTION OF
ADJACENT
MUSCULOSKELETAL
STRUCTURES, SUCH AS
SACRUM OR PART OF
LUMBAR SPINE.
EXTENDED
HEMIPELVECTOMY
BONY SECTION DIVIDE
ILIUM ABOVE THE
ACETABULUM,
PRESERVING THE CREST
OF THE ILIUM.

67. PROSTHESIS FOR HEMIPELVECTOMY

69. AMPUTATIO
N IN
CHILDRENCATEGORIES-
• CONGENITAL (60%)-
PHACOMELIA , HEMIMELIA.
• ACQUIRED (40%)-
SECONDARY TO TRAUMA,
NEOPLASM AND INFECTION.
DYSVASCULAR AMPUTATION
IS RARE IN CHILDREN.

70. GENERAL PRINCIPLES OF
CHILDHOOD AMPUTATION BY
KRAJBICH
PRESERVE LENGTH
PRESERVE IMPORTANT GROWTH PLATES
PERFORM DIARTICULATION RATHER THAN TRANSOSSEOUS AMPUTATION WHENEVER POSSIBLE.
PRESERVE KNEE JOINT WHEN EVER POSSIBLE.
STABILIZE AND NORMALIZE THE PROXIMAL PORTION OF LIMB.
BE PREPARED TO DEAL WITH ISSUES IN ADDITION TO LIMB DEFICIENCY IN CHILDREN WITH OTHER CLINICALLY IMPORTANT
CONDITION.

71. COMPLICATIO
N IN
CHILDHOOD
AMPUTATION
TERMINAL OVERGROWTH-
MORE COMMON AFTER
TRAUMATIC AMPUTATION.
• TREATMENT- CAPPING THE
BONE WITH EPIPHYSEAL
GRAFT HARVESTED FROM
AMPUTED LIMB OR
TRICORTICAL ILIAC CREST
GRAFT.

72. ADVANTAGE IN
CHILDHOOD
AMPUTATION
• LESS INCIDENCE OF PHANTOM LIMB.
• EXTENSIVE SCARS ARE TOLERATED
WELL.
• PSYCHOLOGICAL PROBLEMS ARE RARE.
• FUNCTIONS WELL WITH SIMPLE
PROSTHESIS.
• SPUR MAY DEVELOP BUT ALMOST NEVER
REQUIRE RESECTION.

73. THANK YOU
AMPUTATION SHOULD BE CONSIDERED AS A
RECONSTRUCTIVE PROCEDURE NOT AS FAILURE OF