Amputations:
Removal of limb , partly (or) totally, from the body is termed as amputation.
Disarticulation is v removing the limb through a joint.
Amputations are more common in men and more often in the lower limbs.
TYPES:
There are two types of amputations. They are.
closed amputation
Open a amputation
Closed Amputation:
This is fine most of the times as an electrical procedure and may be above kneev (or) below knee, above elbow and below elbow, etc.
In this type of amputation, the skin is closed primarily over the bong stump by retaining skin and muscles at least 5cm distal to the bone end to facilitate closing of the stump .
Open Amputation:
Undertaken as an emergency procedure is also called “Guillotine amputation.”
In this type of amputation, the skin is not closed over the amputation stump.
After amputation, the stump is left open and dressed regularly till the infection subsides and the stump wound becomes healthy.
Level of Amputation:
In a limb an amputation is carried out at a level which will give the stump an option length to facilitate subsequent prosthetic filling.
Fore - quarter
Shoulder disarticulation
Above elbow
Below elbow
Wrist disarticulation
Fore- quarter amputation:
● Here the amputation is carried out proximal to the shoulder joint and part of the scapula and clavicle are removed along with the shoulder girdle muscles.
● It is indicated for malignant bone tumours of the upper end of humerus.
Disarticulation of shoulder:
● This is not common done . head of the humerus is preserved even during disarticulation to preserve the contour of the shoulder.
● It is indicated for malignant bone tumours of the upper end of humerus.
Above elbow amputation:
● A 20cm long stump as measured from the tip of the amino is ideal.
Below elbow amputation:
● The optimum length of a below elbow stump is 20cm as measured from the tip of olecranon, with a minimum length of 7.5cm.
krukenberg amputation:
● This is a below elbow amputation done usually on both sides.
● Here, the forearm is split between the radius and ulna.
● This can be used like a fork and it provides a" pincer grip."
● A below elbow prosthsis ( Or) a" hook " prosthesis can be pit over the stump to lift the heavy objects.
Amputation through the hand:
● Here the dictum is to preserve as much length as possible. This holds good for the thumb also.
● But, for the proposal phalanx of other fingers, a short stump will not serve any purpose, hence amputation through the neck of the metacarpal bone is preferred.
Hind- quarter amputation
Above knee amputation
Below knee amputation
Disarticulation
Handsome quarter amputation:
● Here part of the pelvis is removed along with the lower limbs.
● It is indicated for malignant tumours of the pelvic bone and upper end of femur.
Above knee amputation:
● The optimum length of the above knee stump is about 25-30cm as measured from the tip of the greater trochanter.
● The minimum length for a useful stump is about 7.5cm.
Below knee amputation:
● The amputation is performed through the leg bones.
● The optimum length of the below knee stump is 14cm from the tibial tubercle.
● PTB ( patellar tendon bearing) prosthesis, is commonly used for an amputation done at the ideal level, and a below knee prosthesis for a short stump.
Disarticulation:
● It can be done through the hip and knee as well.
● Knee disarticulation is not a very popular method due to the bully stump.
● Below knee amputation is generally preferred to the through knee disarticulation.
symes' amputation:
● Here the tibial and fibula are divided just above the ankle joint.
● The heel with (or) without the calcaneum is attached back to the end of the stump.
Indications:
Trauma:
Trauma due to RTA, industrial accidents,etc. are common in young people.
The limbs with severe crush injuries and total loss of blood supply often require amputation as a life saving measure.
Malignant Tumors:
The presence of malignancy often needs amputation which is usually extensive, performed through the normal tissues proximal to the diseased part.
This is done to save life and to prevent recurrence.
Nerve Injuries and Infections:
Anaesthetic limb often develops ulcerations, infections and severe tissue damages.
The tissue damage due to repeated infectiond and ulcerations may lead even to auto- amputation in neglected patirnts.(e.g hensen’s disease.)
Malformations:
Rudimentary limbs, accessory thumb congenital absence of bones,etc need amputations.
Severe Infections:
Severe infections like gas gangrene (or) chronic intractable infections like osteomyelities, unstable diabetes mellitus .
