•Dr Chirantan M S

Principles of •PG- Orthopaedics

Amputation •SMCH
•Ghaziabad
Definition
Defined as surgical ablation of a part or whole of limb through one or more bones.

When its through a joint Disarticulation.

Introduction
• Not a failure of surgery, but a reconstructive procedure

• Goal is surgical reconstruction that maintains most functional limb possible

Introduction
History
• Earliest reference in Babylonian code of Hammurabi-1700BC.

• Hippocrates in De Articularis-385 BC.

• William Cloves did first successful AKA-1588.

• Botallus and FabricusHoldani described use of torniquet-16 th century.

• Norman Kick used Guillotine amputation during World War-1943.

Introduction
Epidemology

• 350000-1million amputees

• 20000-30000 new amputees per year

• Age: 50-75 yrs

• >> lower limbs

• >>Males
 • Emergency/Traumatic/Elective
• Provisional/Definitive
• Open/Closed
• End bearing/Cone bearing
• Named/Eponymous amputations
Classification • Gritt-Stoke
• Syme
• Progoff
• Chopart
• Lisfrank
• Ray
Intra operative principles

• Determine outcome of function and rehabilitation

• Meticulous attention to detail and careful soft tissue handling

• Effort to be directed at achieving ideal stump

Traditional Sites
• Upper Limb
• A/E - 20cm from Acromion
• B/E – 18cm from Olecranon

• Lower Limb
• A/K -12cm from Joint line
• B/K – 14cm from Joint line
Site Selection
Examination
• Skin color
• Hair growth
• Lowest palpable pulse
• Skin temperature

Investigation
• Doppler Ultrasound Study
Intra Operative
Principles

Closing the wound

• Hemostasis is secured
• Opposing group of muscles are sutured
across both the ends with interrupted
sutures
• Fascia & skin are sutured over muscle
without tension
• Preferably a suction drain is placed.
• Wound is covered with gauze & roller
bandages tightly from below upwards.
Intra Operative Principles
Open Amputation
• Indications-
• Infected limb
• Battle injuries
• Soft tissue injury/contamination
• Uncertain blood loss
• Types
• Inverted edges
• Circular
Intra Operative Rigid Dressing Soft Dressing
Principles • Decreases edema • The stump is dressed
with sterile dressing &
• Decreases post op pain crepe bandage applied
over it
Wound Dressing: Soft vs Rigid • Protects limb from
trauma

• Early mobilization

• Good bandage to mold

the stump into conical
shape to accept the
prosthesis
Post Operative care
General –
• Analgesics
• Antibiotics
• DVT prophylaxis
Specific –
• Joint positioning + exercise
• Drain removal
• Mobilization
• Rehab: prosthetic fitting, home office & hobby
Phantom Sensation
• It is the sensation of the limb that is no longer there. The phantom, which. Usually occurs
initially immediately after the surgery, is often described as a tingling, burning, itching or
pressure sensation, sometimes a numbness

• Phantom sensation may be painless although, most people find it uncomfortable & often
report it as pain; it usually does not interfere with prosthetic rehabilitation
Phantom limb pain
• Phantom pain & sensation are defined as perceptions ranging from slight tingling to
sharp, throbbing pain or aching that patients perceive relating to an extremity or an organ
that is physically no longer a part of the body.

• It has been reported in various trials that the estimated prevalence of phantom pain varies
from 49% to 83%
Rehabiltiation
• Residual limb shrinkage & shaping

• Limb desensitization

• Maintaining joint ROM

• Strengthening residual limb

• Maximum self reliance

• Patient education; future goals & prosthetic options

Prosthetics

• It is a replacement of substitution of a
missing or a diseased part
Types
Temporary
• Used following amputation till patient is fitted with permanent prosthesis.
• Eg; pylon

• Permanent prosthesis
Conclusion • Goal is to achieve useful residual limb in an
individual who is active with a positive attitude and
continues to be a productive member of society