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Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities

Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities. Indications to Amputations. 1. Trauma and its complications (anaerobic infection, osteomyelitis) 2 . Malignant tumors of skeleton and soft tissues of limbs

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Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities

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  1. Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities

  2. Indications to Amputations 1. Trauma and its complications (anaerobic infection, osteomyelitis) 2. Malignant tumors of skeleton and soft tissues of limbs 3. Vascular diseases (thrombosis, diabetic angiopathy, obliteratingendarteritis)

  3. Indications to Amputations • I. Absolute • Traumatic limb rupture • Gangrene • - injury of 2/3 of soft tissue - injury and crushing of major vasculo-nervous bundles -injury of bone • II. Relative • Acute infectious process • Chronic infection • Massive trophic ulcer • Irreparable deformation of limb • - injury of 2/3 of soft tissue - injury of bone on considerable distance - without injury of vasculo-nervous bundle

  4. Classification of Amputations • Primary amputation (within first 24 hours) • Secondary amputation (7-8 days after injury) • Re-amputation (repeated amputation)

  5. Standard Above-knee Amputation (AKA)

  6. Steps of Amputation I. Cutting of soft tissue II. Treatment of periosteum and cutting of bone III. Stump treatment

  7. Stages of Transfemoral Amputation

  8. Types of Amputations (according to soft tissues cutting) 1. Flap amputations: - single-flap amputation - double-flap amputation 2. Circular amputations: - one-step (guillotine) amputation - two-step amputation (variety – “cuff” method of forearm amputation) - three-step (conical-circular) amputation

  9. Transfemoral amputation – Above-knee Amputation: marking-out of skin flaps

  10. Creating of Flaps and Cutting of Soft Tissues

  11. Callander Amputation (this gives an excellent end-bearing stump)

  12. Methods of Periosteum Treatment 1. Periosteal 2. Aperiosteal 3. Subperiosteal

  13. Treatment of Periosteum and Cutting of Bone

  14. Exposureand Ligation of Main Vessels

  15. Arrest of Bleeding from Small Vessels by Electro coagulation after Removing of Tourniquet

  16. Exposureand Cutting of Nervous Trunks

  17. Stitching of Soft Tissues above Bone Stump and Draining of Wound

  18. Aseptic Bandage and Immobilization of the Limb Stump

  19. Different Types of Prosthesis

  20. The most common complications of amputation are: • massive haemorrhage • infection • skin breakdown caused by immobility, pressure, and other sources of irritation • breathing problems associated with immobility • neuromas • joint contractures • bone overgrowth (in children)

  21. Complications of Amputation • Mistakes of I step of amputation: 1. conical stump 2. mace-shaped stump • Mistakes of II step of amputation: 3. terminal necrosis of bone 4. forming of large osteophytes • Mistakes of III step of amputation: 5. forming of trophic ulcers 6. phantom pain • 7. Chronic osteomyelitiscaused by secondary infection inside a wound

  22. Osteo-plastic Amputations(Gritti-Stokes and Sabanajeff amputations)

  23. Pirogoff Amputation

  24. Amputation in Middle Third of Leg

  25. Syme Amputation

  26. Schemes of Foot Amputations

  27. Thank You for Attention!

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