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Amputations: by Saif Ali BPT III Year
Amputations: by Saif Ali BPT III Year
By
Saif ali
Bpt III year
Amputate means cutt off
The word “Amputate” was employed to cutting off the hands of criminals
INTRODUCTION
● “Amputation is the removal of limb, Part (or)
total from the body
● It is also defined as the removal of an
extremity by trauma, prolonged
construction, medical illness (or) surgery
● It is a procedure where a part of limb is
DEFINITION removed through one or more bones
● Amputation – through bone
● Disarticulation – through joint
● Amputation of lower limb is more common
than upper limb
● Age -
Common in age group between 50 – 70 years
● Gender -
Males 75%
INCIDENCE Females 25%
● Limbs -
Lower limb - 85%
Upper limb - 15%
● By trauma i.e., RTA , Falling from heights
● Severe infection
● Malignant tumors
INDICATIONS ● Peripheral vascular insufficiency
● Heat and cold burn
● Gangrene
● Congenital absence of limbs (or) malformation
~ Natural Causes
● Congenital absence
● Arterial disease
● Frostbite
● Wound infections
● Diabetes mellitus
● Tumors
~ Accidental causes
CAUSES ● RTA , falling from heights (or) when running
● Attack from crocodiles and sharks
● Effects of earthquakes, tsunamis and voilent storms
~ Ritual, Punitive and legal Amputation
● Curing local pain
● In removing deformity
● Infection (or) Gangrene
Reasons for Amputation
1. Circulatory Disorders
• Diabetic foot infection/gangrene
(most common cause for non traumatic amputation)
• Sepsis with peripheral necrosis
2. Neoplasm
• Cancerous bone (or) soft tissue tumors
• Examples- Osteosarcoma, osteochondroma
Fibrosarcoma, epithelioid sarcoma
Ewing’s sarcoma, synovial Sarcoma,
Sacrococcygeal Teratoma
• Melanoma
3. Trauma
• Severe limb injuries where the limb cannot be spared (or) attempts to spare the
limb have failed
• Traumatic amputation occurs at the scene of accident , where the limb is
partially (or) wholly severed
4. Infection
• Bone infection ( osteomyelitis)
• Preservation of life
• Improvement of general health
• Restoration of function
• Reduction of pain
Types of Amputation
~ Closed Amputation
● Musculoskeletal Pain :
Pain from other injuries
Pain caused by abnormal gait patterns
Pain caused by normal ageing process
Excessive wear and year on the joints and soft tissues of the residual
limb
Muscle Weakness, Contractures and joint Instability
● After amputation, it is common for patients to
experience pain, muscle weakness or
instability in structures that are not directly
associated with the Amputation
● Muscles and joints that are required to perform
additional functions post Amputation, often
resulting in stiffness ,spasm or pain
● Hip flexion Contractures and knee flexion
Contractures are common complications post
Amputation and can impact on prosthetic
rehabilitation
● Deformity complicates the process of
prosthetic fitting and ambulation
Painful adhesive scar formation :
● Painful scar over the surgical incision poses a problem in the process of
rehabilitation
● It may obstacle in fitting prosthesis
● Early mobilization of the painful scar is recommended with the therapeutic
modalities
Hyperesthesia of the stump:
● hyperesthesia means hypersensitivity, this ia another annoying
symptom that is difficult to control
Neuromas :
● Localised pain, sharp/shooting/ paraesthesia reproduced by local
palpation
Causalgia :
● Intense burning pain that results from injury to a peripheral nerve
REHABILITATION OF LL AMPUTATION
• Assessment
• Physical
• Social
• Psychological
• Training
• Re-assurance
Pre Operative Assessment
• Assessment of
• The affected limb
• The unaffected limb
The patient as a whole is conducted
thoroughly
• Assessment of physical, social and
psychological status of the patient
should be made
Physical Assessment
○ BELOW KNEE
i. PATELLA TENDON BEARING (PTB)
○ MID THIGH
Re - education with prosthesis
● After satisfactory fitting of prosthesis the process of
training & re- education begins
● It includes the following:
○ correct methods of applying & removing of
prosthesis
○ Early detection of any complication due to prosthesis
○ Functions of various components of prosthesis
○ Limitation of activities with prosthetic limb
RESTORING FUNCTIONAL INDEPENDENCE