AMPUTATION

ISTAN I IRSAN
KOLEGIUM ILMU ORTHOPAEDI & TRAUMATOLOGI INDONESIA
be regarded as a treatmen
 Indication of
amputation

Dead or Dying Limb

Dangerous Limb
Damn Nuisance Limb
 Dead or Dying
Limb
Peripheral vascular disease
( 90 % )
Severe traumatised limb
Burns
Frostbite
 Dangerous Limb

Malignant tumors
Lethal sepsis
Crush Injury leading to crush
syndrome
 Damn Nuisance
Remaining the limb is more worse
than having no limb at all

Pain
Gross Malformation
Recurrent Sepsis
Severe loss function
 Varieties of
Amputations
Provisional Amputation
Definitive end-bearing
Definitine non-end
bearing
 Provisional
Amputation
Primary healing is
unlikely

The limb
amputee as distal
as the causal
factor will allow

Re-amputation
perform when
stump condition
is favourable
 Definitive end-
bearing
When weight is
taken through the
stump

Scar must not be

terminal

Bone end must be

solid

Symes technique
 Definite non end-
bearing
Commonest
variety

The scar can

be terminal

All upper limb

and most lower
limb
Determination of Amputation lev
Technical Aspects
Open / Close Amputations
Post Operative Care
 LEVEL OF
AMPUTATION

DECREASED
INCREASED
COMPLICATION
FUNCTION
PROXIMAL
DISTAL LEVEL
LEVEL
 LEVEL OF
AMPUTATION
 LEVEL OF
AMPUTATION
 AMBULATORY STATUS

Patient has no ambulatory potential,

wound healing with decrease perioperative
morbidity should be the chief concern

Trans tibial amputation in this setting is

not a reasonable option
 TISSUE AND SKIN PERFUSION

Lasser Doppler Flowmetri

Tissue clearance with fluoresin
Trancutaneous Oxygen Perfusion
 SKIN FLAP
Healthy skin coverage
Should be mobile
Normal sensation
Scar should nor be adherent
Avoid redundant tissue or
dog ears
TECHNICAL ASPECT
HEMOSTASIS

TORNIQUET OR NO TORNIQUET
 TECHNICAL ASPECT

SKIN AND MUSCLE FLAPS

IMMEDIATE OR LATE PROSTHESIS

MYODESIS OR MYOPLASTY
TECHNICAL ASPECT

NERVES

PREVENT
NEUROMA
 TECHNICAL ASPECT

BONES

PREVENT EXCESSIVE PERIOSTEAL STRIPPING

 OPEN AMPUTATION

INDICATED FOR :

INFECTION
SEVERE TRAUMATIC WOUND
 OPEN AMPUTATION

WOUND MANAGEMENT

inverted skin flaps

traction post open amputation
vacuum-asissted closud

secondary reamputation plastic repair

closure
OPEN AMPUTATION
OPEN AMPUTATION
OPEN AMPUTATION
 POST OPERATIVE CARE

SOFT DRESSING OR RIGID DRESSING

IMMEDIATE OR LATE PROSTHETIC FITTING
POST OPERATIVE CARE
 POST OPERATIVE CARE

SHIFTING PARADIGMA FROM SOFT

DRESSING TO RIGID DRESSING

PREVENT EDEMA
PROTECT THE WOUND
ENHANCE WOUND HEALING
EARLY MATURATION OF THE STUMP
DECREASE POST OPERATIVE PAIN
PREVENT CONTRACTURE
STUMP EXERCISE
 COMPLICATION

hematoma
infection
wound necrosis
contractures
pain
dermatological problems
 AMPUTATION IN CHILDREN

Krabjich, et. al

e general principles of childhood amputation surg

1.Preserve lentgh
2.Preserve important growth plates
3.Perform disarticulation rathen than
transosseus
4.Preserve knee joint whenever possible
5.Stabilize and normalize the proximal portion
of the limb
TERIMA KASIH