Indications to Amputations

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Lower Limb Amputations – Level Selection

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Presentation transcript:

Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities

Indications to Amputations 1. Trauma and its complications (anaerobic infection, osteomyelitis) 2. Malignant tumors of skeleton and soft tissues of limbs 3. Vascular diseases (thrombosis, diabetic angiopathy, obliterating endarteritis)

Indications to Amputations I. Absolute Traumatic limb rupture Gangrene - injury of 2/3 of soft tissue - injury and crushing of major vasculo-nervous bundles -injury of bone II. Relative Acute infectious process Chronic infection Massive trophic ulcer Irreparable deformation of limb - injury of bone on considerable distance - without injury of vasculo-nervous bundle

Classification of Amputations Primary amputation (within first 24 hours) Secondary amputation (7-8 days after injury) Re-amputation (repeated amputation)

Standard Above-knee Amputation (AKA)

Steps of Amputation I. Cutting of soft tissue II. Treatment of periosteum and cutting of bone III. Stump treatment

Stages of Transfemoral Amputation

Types of Amputations (according to soft tissues cutting) 1. Flap amputations: - single-flap amputation - double-flap amputation 2. Circular amputations: - one-step (guillotine) amputation - two-step amputation (variety – “cuff” method of forearm amputation) - three-step (conical-circular) amputation

Transfemoral amputation – Above-knee Amputation: marking-out of skin flaps

Creating of Flaps and Cutting of Soft Tissues

Callander Amputation (this gives an excellent end-bearing stump)

Methods of Periosteum Treatment 1. Periosteal 2. Aperiosteal 3. Subperiosteal

Treatment of Periosteum and Cutting of Bone

Exposure and Ligation of Main Vessels

Arrest of Bleeding from Small Vessels by Electro coagulation after Removing of Tourniquet

Exposure and Cutting of Nervous Trunks

Stitching of Soft Tissues above Bone Stump and Draining of Wound

Aseptic Bandage and Immobilization of the Limb Stump

Different Types of Prosthesis

The most common complications of amputation are: massive haemorrhage infection skin breakdown caused by immobility, pressure, and other sources of irritation breathing problems associated with immobility neuromas joint contractures bone overgrowth (in children)

Complications of Amputation Mistakes of I step of amputation: 1. conical stump 2. mace-shaped stump Mistakes of II step of amputation: 3. terminal necrosis of bone 4. forming of large osteophytes Mistakes of III step of amputation: 5. forming of trophic ulcers 6. phantom pain 7. Chronic osteomyelitis caused by secondary infection inside a wound

Osteo-plastic Amputations (Gritti-Stokes and Sabanajeff amputations)

Pirogoff Amputation

Amputation in Middle Third of Leg

Syme Amputation

Schemes of Foot Amputations

Thank You for Attention!