Levels of amputation

Traditionally, levels of amputation have been identified by anatomical considerations such as below
knee and above knee. In 1974, the Task Force on Standardization of Prosthetic-Orthotic Terminology
developed an international classification system to define amputation levels.

Partial toe Excision of any part of one or more toes

Toe disarticulation Disarticulation at the metatarsal phalangeal joint

Partial foot/ray resection Resection of the 3rd, 4th, 5th metatarsals and digits

Trans-metatarsal or Amputation through the midsection of all metatarsals

Chopart’s amputation
Ankle disarticulation Ankle disarticulation with attachment of heel pad to distal end of tibia may
(Syme’s) include removal of malleoli and distal tibial/fibular flares

Long transtibial (below More than 50% of tibial length

knee)

Transtibial (below knee) Between 20% and 50% of tibial length

Short transtibial (below Less than 20% of tibial length

knee)
Knee disarticulation Amputation through the knee joint; femur intact

Long transfemoral (above

knee) More than 60% of femoral length

Transfemoral (above knee) Between 35% and 60% of femoral length

Short transfemoral (above Less than 35% of femoral length

knee)
Hip disarticulation Amputation through hip joint; pelvis intact

Hemipelvectomy Resection of lower half of the pelvis

Hemicorporectomy Amputation both lower limbs and pelvis below L4–L5 level
Muscle stabilization post-surgery is obtained by the following:
Myofascial closure Muscle to fascia
Myoplasty Muscle to muscle
Myodesis Muscle to bone or periosteum
Tenodesis Tendon to bone
It is important for some sort of oedema control to be used because excessive oedema in the residual
limb can compromise healing and cause pain.
Types of dressings used in amputation surgery:
Type of Dressing Advantages
Compressible soft dressing Easy to apply
Inexpensive
Easy access to incision
Shrinker Easy to apply
Inexpensive
Semi rigid dressing Better edema control than
soft dressing
RL protection
Immediate postoperative Excellent edema control
prosthesis or rigid dressing Excellent RL protection
Control of RL pain
Disadvantages
Little edema control
Minimal residual limb (RL)
protection
Requires frequent
rewrapping
Not used until sutures are
removed
Requires changing as RL
shrinks
Needs frequent changing
Cannot be applied by patient
No access to incision
No access to incision
More expensive than other
dressings
Requires proper training for
use