1. AMPUTATIONS

2.  DEFN-REMOVAL OF THE LIMB THROUGH A
PART OF THE BONE.
 DERIVED FROM LATIN WORD “AMPUTARE”
MEANING ‘CUTTING AROUND’
 INCIDENCE:AGE-50-75 YRS
SEX-MALES[75%]
LIMBS-LOWER LIMB[85%]

3. • POOR CIRCULATION -POVD, DIABETES
• INJURY
• TRAUMA
FROST BITE,BURNS
• INFECTIONS
FULMINANT GAS GANGRENE,C/C
OSTEOMYELITIS,INFECTED NON UNIONS,C/C
INFECTED TROPHIC ULCER
DEAD,DYING,DEVITALISED TISSUES.

4.  TUMOURS-OSTEOSARCOMA
 CONGENITAL ANOMALIES
most common indication in children

5. • CLOSED AMPUTATIONS
FLAPS ARE FASHIONED AND ARE CLOSED
PRIMARILY ALONG WITH SURGERY.
• OPEN AMPUTATIONS
FLAPS ARE NOT CLOSED PRIMARILY
LATER REVISED AMPUTATION, REAMPUTATION
OR PLASTIC REPAIR
1.GUILLOTINE TECHNIQUE
ALL THE TISSUES ARE CUT AT THE SAME
LEVEL.IN SEVERE CRUSH INJURIES AND SEVERE
INFECTIONS.

6.  CIRCULAR AMPUTATION
WITH FLAPS RETAINED FOR LATER
DELAYED SUTURING.
OTHER TYPES
 REVISION AMPUTATION-for ideal stump
 REAMPUTATION

7.  NON-END BEARING/SIDE BEARING
 -Weight is taken up by the joint
 END BEARING/CONE BEARING
 -Weight is taken up by the body.

8. • HIGHER THE LEVEL OF AMPUTATION
GREATER IS THE DIFF TO RESTORE ABILITY
• AMPUTATION STUMP SHOULD BE LONG
ENOUGH
• IF A JOINT IS ARTHRODESED,SECTION AT
JOINT LEVEL OR ABOVE
• POVD-LEVEL SHOULD BE BELOW THE DISTAL
MOST ARTERIAL PULSATION
• IN ELDERLY FRAIL-BK AMPUTATION
• OTHERWISE KNEE DISARTICULATION

9.  IN CLINICAL PRACTICE
COLOUR AND TEMP OF THE SKIN BEFORE
SURGERY
APPEARANCE OF FREE CAPILLARY
BLEEDING FROM CUT SURFACES ON
OPERATION

10. • SHOULDER DISARTICULATION
• SHORT ABOVE ELBOW
• STANDARD ABOVE ELBOW
• LOW ABOVE ELBOW
• ELBOW DISARTICULATION
• SHORT BELOW ELBOW
• MEDIUM BELOW ELBOW
• LONG BELOW ELBOW
• WRIST DISARTICULATION

12.  BELOW KNEE-THRU THE TIBIA-FIBULA
 SYME’S –THRU THE ANKLE JOINT
 CHOPART’S-THRU THE MIDTARSAL JOINT
 LISFRANC’S-THRU THE INTERTARSAL
JOINTS.

13. • ANAESTHESIA-GA OR SAB
• TOURNIQUET
CONTRA INDICATED IN ISCHAEMIC LIMB AND
ATHEROSCLEROSIS
EXSANGUINATION PRIOR TO TOURNIQUET
APPLICATION-CONTRA INDICATED IN INFECTED
LIMBS AND MALIGNANCIES
• SKIN FLAPS-GOOD
COVERAGE,MOBILE,ADEQUATE LENGTH

14. • MUSCLES
SECTIONED 5 CM DISTAL TO BONY
SECTION
1.MYODESIS-SUTURING TO BONE
(CI-ISCHAEMIC LIMB)
2.MYOPLASTY-OPPOSING MUSCLES ARE
SUTURED
ADVANTAGES-
• SHAPE OF THE STUMP GOOD

15.  INSULATE CUT NERVE ENDINGS
 MUSCLES ORIGINATING PROXIMALLY
PROVIDE GOOD LEVERAGE
 PHANTOM PAIN MAY BE PREVENTED
 PREVENT RETRACTION &PAINFUL MUSCLE
CONTRACTION

16. • BLOOD VESSELS
DOUBLE LIGATION AND CUT
• NERVES
PULLED AND CUT SO THAT IT RETRACTS
INTO THE STUMP
• BONES
PERIOSTEAL STRIPPING MINIMISED
• DRAIN
48-72 HRS

17.  DRESSINGS
1.RIGID DRESSING-POP CAST
DECREASED STUMP EDEMA,EARLY
HEALING,LESS POST OP PAIN,TEMPORARY
PROSTHETIC FITTING
2.SOFT DRESSING-SOFT BANDAGES AND
ELASTOCREPE BANDAGES

18. • BEGIN ASAP
• GOALS –REDUCE EDEMA, INCREASE
STRENGTH, PREVENT CONTRACTURES,
MAXIMISE FUNCTIONAL INDEPENDENCE.
• BALANCE & COORDINATION ACTIVITIES FOR
GAIT TRAINING.
• WALKING AIDS
• ALSO VOCATIONAL TRAINING, PAIN MNGMT,
PSYCHO EDUCATION.

19. • HAEMATOMA
• INFECTIONS
• NECROSIS OF SKIN FLAPS
• CONTRACTURES
• PAINFUL NEUROMAS
• PHANTOM LIMB

20. • IDEAL LENGTH
• IDEAL SHAPE
• MUSCULAR
• GOOD POWER OF MUSCLES
• NO FIXED DEFORMITY
• FULL AND FREE MOVTS OF JOINT ABOVE
• INFN FREE
• NON ADHERENT INCISION SCAR
• ABSENCE OF NEUROMA

21. CAN BE ACHIEVED BY
• STUMP DRAINAGE
• STUMP SPLINTING
• STUMP BANDAGING
• STUMP EXERCISES EARLY
• STUMP HYGEINE

22.  MC AMPUTATION PERFORMED
 A LONG POSTERIOR FLAP WITH SCAR PLACED
OVER ANTERIOR ASPECT IS USED.
 PROSTHESIS PLACEMENT IS BETTER HERE
WITH GREATER RANGE OF MOVTS WITHOUT
LIMP AND WITHOUT SUPPORT.
 FIBULA SHOULD BE DIVIDED FIRST
 TIBIAL STUMP SHUD BE BEVELED ANTRLY
 POSTR MUSCLES ARE SUTURED ACROSS THE
BONE ENDTO THE PERIOSTEUM IN FRONT.

23. ANKLE DISARTICULATION,REMOVAL OF
MALLEOLI AND ANCHORING HEEL PAD TO
THE WEIGHT BEARING AREA

24.  TWO POINTS 1.75 CM BELOW LAT
MALLEOLUS AND 2.5 CM BELOW MED
MALLEOLUS ARE JOINED INFRONT OF THE
ANKLE AND ALSO VERTICALLY ACROSS THE
HEEL PAD

25.  ANT INCISION DEEPENED-TALUS AND
CALCANEUM REMOVED LEAVING ALL SOFT
TISSUE IN THE FLAP
 MEDIAL AND LATERAL MALLEOLI ALONG
WITH A THIN SLICE OF TIBIA REMOVED
 ADV-PATIENT CAN WALK WITHOUT A
PROSTHESIS

26.  AMPUTATION THROUGH INTER TARSAL
JOINTS
 SEVERE EQUINUS DEFORMITY
FRICTION IN ANTERO POSTERIOR PART OF
THE STUMP.

27.  AMPUTATION THROUGH MID TARSAL JOINT
 SUBTALAR FUSION AND ELONGATON OF
TENDO ACHILLES

28. PIGROFF’S AMPUTATION
 ANT PART OF CALCANEUM IS CUT ACROSS
AND RAW BONE IS FIXED TO THE RAW
UNDERSURFACE OF TIBIA
 CALCANEAL TUBEROSITY -WEIGHT BEARING
AREA

29. BOYD’S AMPUTATION
 TALUS IS EXCISED
 CALCANEUM IS ADVANCED AND ATTACHED
TO THE RAW UNDERSURFACE OF TIBIA
 STABLE LOAD BEARING SURFACE

30. THANK
YOU