Amputation is defined as removal of the limb through a part of the bone.
Age common in 50 to 70 years age group.
Sex 70% men, 25 % women
Limbs 85% is through the lower limbs, 15 % is through the upper limbs
PRINCIPLES OF AMPUTATIONS:
Closed Amputations: In this the skin is closed primarily after amputation.
Tourniquets: These are desirable except in ischemic limbs.
Level of amputation: As in the past the level of amputation is no longer important, thanks to the modern and sophisticated present day prosthesis.
Skin flaps: Good skin coverage for the amputation site is of vital importance. The skin should be mobile and sensitive. Location of the scar is not important
Muscles: The muscle is divided at least 5 cm distal to the level of intended bone section and sutured.
Open Amputations(Guillotine operation):In this type of amputation the skin is not closed primarily and later it is followed by any one of the closure methods like secondary closure, reamputation, revision amputation or plastic repair.
In patients less than 50 yrs of age: Trauma due to RTA, industrial accidents, etc. are common in young people. Crush injuries devoid of blood and nerve supply warrant amputations.
More Than 50 years: Diseases like Buerger’s disease, diabetes, atherosclerosis, etc. are common after 50 years .These disease usually lead to gangrene which warrant amputations.
Less common causes:
Infections: Severe infections like gas gangrene, Hansen’s disease, severe osteomyelitis, etc. rarely require amputation and are indicated when all other measures fail.
Malignancy Advanced stages of malignant bone tumors need amputations.
Nerve injuries: A severe anesthetic limb due to extensive nerve injuries requires amputation.
Severe congenital anomalies; Rudimentary limbs, accessory thumb, congenital absence of bones, etc. need amputations
Severe cold or heat: Severe burns or extreme cold, like frostbite, electrical burns, etc. require amputation of the limbs in rare instances.
TYPES OF AMPUTATIONS:
Closed Amputations: This is done most of the times as an elective procedure and may be above knee or below knee, above elbow and below elbow, etc. Here after the amputations, the soft tissues are closed primarily over the bony stump.
Open Amputation: In open amputation, the wound is left open over the amputation stump and is not closed. This is done as an emergency procedure in the face of life-threatening infections. There are two types in this depending upon the skin flaps.
Open amputations with inverted skin flap.
Circular open amputation
In this type of amputation skin is closed at a later date.
Aims: The amputation should be carried out at a level which will give a stump of optimum length to facilitate prosthetic fitting at later stages.
Short above elbow
Standard above elbow
Very short below elbow
Medium below elbow
Long below elbow
Very short above knee
Short above knee
Medium above knee
Long above knee
Very long above knee
Very short below knee
Short below knee.
Syme’s amputation: Here the level of bone section is 0.6 cm proximal to the ankle joint.
Sarmiento’s amputation: Here the level is 1.3 cm proximal to the joint.
Wagner’s is two-stage Syme’s amputation.
Boyd’s: This consists of talectomy and calcaneotibial arthrodesis.
Pirogoff’s amputation: In this only anterior part of the calcaneum is removed
Amputation of great toes and other toes
Amputation through the metatarsal bones
Lisfranc’s operation: amputation is at the level of the tarsometatarsal joints(lisfranc joint)
Chopart’s operation: Amputation is through the midtarsal joints
Necrosis of the skin flaps
Phantom limb sensation
BELOW KNEE AMPUTATION
This is the most common amputation performed techniques vary in non ischaemic and ischaemic
NON ISCHEMIC LIMBS:
Here the ideal level of amputation is at the musculotendenious junction of the gastronemius because distal to this level the tissue are relatively Avascular and soft tissue padding is scanty. Though soft tissue may heal early, it usually breaks down later due to the prosthetic use and advancing physiologic age.
Here the skins blood supply is better to the posterior than the anterior. Hence a long posterior flap is preferred in ischemic limbs. To preserve vascular connections, unnecessary dissections are avoided. Unlike in non ischemic limbs, amputation is performed at a higher level tension myodesis and myoplasty are contraindicated for fear of damaging the already precarious blood supply.
PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY
At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:
Prescription of orthoses and prostheses
Management of stump: Stump cleanliness
Kindly contact PHYSIOLINE for further consultation and rehabilitation