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Indications to Amputations

Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower Extremities Associate-professor Kovryha M. F. 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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Indications to Amputations

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  1. Basic Surgical Principles of Amputations and Disarticulations of the Upper and Lower ExtremitiesAssociate-professor Kovryha M. F.

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

  4. Levels of Amputations

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

  6. 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

  7. Standard Above-knee Amputation (AKA)

  8. Stages of Transfemoral Amputation

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

  10. Creating of Flaps and Cutting of Soft Tissues

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

  12. Treatment of Periosteum and Cutting of Bone

  13. Exposureand Ligation of Main Vessels

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

  15. Exposureand Cutting of Nervous Trunks

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

  17. Aseptic Bandage and Immobilization of the Limb Stump

  18. The most common complications of amputation are: • massive haemorrhage that occurs when a suture becomes loose • infection • rash, blisters, and skin breakdown caused by immobility, pressure, and other sources of irritation • pneumonia, blood clots, and breathing problems associated with immobility • formation of nerve cell tumors (neuromas) at severed nerve endings

  19. 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

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

  21. Pirogoff Amputation

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

  23. Below-knee Amputation

  24. Amputation in Middle Third of Leg

  25. Schemes of Foot Amputations

  26. Syme Amputation

  27. Sites of Election for Amputations of Upper Extremity

  28. Finger Amputation

  29. Different Types of Prosthesis

  30. Thank You for Attention!

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