AMPUTATIONS

ISMONO DARMADJI

DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY

MEDICAL SCHOOL PADJADJARAN UNIVERSITY
BANDUNG
Primitive Culture
civilized societies (unanesthetized, hemostasis by boiling oil)

Ambroise Pare
A French military surgeon

Morel introduction of the

tourniquet (17th century)

The Committee on Prosthetic

Research and
Development of the
National Academy of
Science
Amputations
 The first step in
returning the patient to
a normal and
productive place in
society
 Plastic and
recontructive
operations, and
rehabilitation.
Indications for Amputation

 Irreparable loss of the

blood supply of a diseased
or injured limb
 Many malignant tumors
 Congenitally abnormal
limb
 Peripheral vascular
disease
 Gangrene
Surgical Principles
of amputations

Closed amputations
 Tourniquet
 Level of amputation
 Skin flaps
– Large dog-ears
 Muscles
– myoplasty-myodesis
– Not too bulky
 Surgical Principles of
Amputations
 Nerves
– neuromas
 Blood vessels
– Large vessels- doubly
ligated
 Bone
– Medullary canal-
osteoperiosteal flaps
 Drains
– Should be used (48-72
hours)
Open Amputations
not closed over the end of the stump

 At least two operations

required to contruct a
satisfactory stump
 Secondary closure
 Reamputation
 Revision
 Plastic repair
Open Amputations
not closed over the end of the stump

 Two general type:

– Open amputations with skin
flaps
– Circular open amputations

 To close secondarily: 10-

14 days

 Use of constant skin

traction that tends to pull
all the soft tissues over the
end of the stump
Open amputations with
skin flaps
 Skin flaps longer than
usual
 Anterior and posterior
flaps of equal length
 Apply pressure with
gauze pads over the
end of the stump
 Interrrupted chronic
catgut sutures
Circular open amputations
 Section the bone at the
ends of the retracted
muscles
 Apply skin traction in the
operating room
 Cover the stump with a
stockinette
 Sterile liquid adhesive
 1,4 – 2,3 kg
 Until the granulating area
is fixed by cicatrix
Foot
Amputations

 Toe amputation
 Base of proximal
phalanx
 Metatarsophalangaeal
joint disarticulation
 Single metatarsal
 mid-foot
Ankle amputations

 Syme
 Two-stage amputation
– Wargner-syme
amputation
 Boyd
Aputations of
lower extremity

 Leg amputations
 Disarticulation of knee
 Thigh amputations
(above-knee
amputation)
  Hematoma
 Infection
Complications  Necrosis
 Contractures
 Neuromas phantom
sensations
Amputations in
Children
 Congenital
 Acquired
– Truma
– Disease
– Malignant

 The factors of general

body growth and stump
growth
 Amputations in
Children

 Child amputees must

be followed closely for
prosthetic repair for
frequent changes in the
socket and for fitting
with nerw prostheses.
King and
Steelquist
hindquarter
amputation
Amputation through distal forearm
Amputation through arm at
supracondylar level
THANK YOU