1. Principles of AMPUTATION Principles of AMPUTATION Dr Firas Mohammed Abdulghani Assistant professor Al-Nahrain medical college

2. OUTLINE  Introduction  epidemology  Indications  Types  Preoperative evaluation  Operative techniques  Postoperative care  Complications  Conclusion

3. Introduction Definition Trans-osseous removal of a limb or part of it. Most ancient surgical procedure Multidisciplinary: Surgeon, Nurses, Prosthetist, Physiotherapist, Occupational therapists, Social worker & Psychologist.

4. Introduction… Amputation: not a failure of Rx, but the 1st step toward a patient's return to a more comfortable & reproductive life. The procedure should be planned & performed with the same care & skill used in any other reconstructive surgery.

5. Introduction… Early surgical amputations ► limb was severed from an unanesthetized patient. Stump was dipped in boiling oil (hemostasis) Stump was poorly suited for prostheses. High mortality rate.

6. Introduction …

7. Hippocrates: first to use ligatures 1529: Popularized by Ambroise Paré Paré also introduced the “artery forceps He also designed sophisticated prostheses 1674: Morel's introduce tourniquet 1867: Lord Lister's introduce asepsis

8. epidemology More than 300,000 pts with amput live in usa About 65,000 amput are performed annually 90% of pt due to peripheral vascular disease In young trauma is the leading cause followed by malignancy

9. Indication Dead limb: o Severe trauma o Peripheral vascular disease o Burns o Frostbite.

10. Indication… Dangerous limb: o Crush injury o Malignancy o Lethal sepsis o Forgotten tourniquet >6hrs.

11. Indication… Damned nuisance: o Gross deformity o Recurrent sepsis o Loss of function. irreversible ischaemia The only absolute indication for amputation is irreversible ischaemia.

12. Types Provisional amputation o Circular or with flaps o When primary healing is unlikely or o Amputate as distal as aetiology will allow o Skin flap is sutured loosely over a pack o Re-amputation perform when stump is ok

13. Types… Definitive end-bearing amputation o Weight is taken through the end of the stump o The scar should not be terminal o Bone end must be solid (cut near the joint)

14. Definitive end-bearing amputation

15. Definitive non-end-bearing amputation Commonest variety All upper limb & most lower limb amputations The scar can be terminal

16. Definitive non-end-bearing amputation

17. Types…

18. Thank you