Presentation about: AMPUTATIONS

Prepared by:Dr. Abdullah K. Ghafour2nd year IBFMS traineeSupervised by: Dr. Ali Abdulnabi Alwan

AMPUTATIONS

Definition

AMPUTATION: Cutting of the extremity or part of the extremity through the bone

While ..

DISARTICULATION: Cutting of the extremity or part of the extremity through the joint

Amputation surgery is an ancient procedure dating back to prehistoric time.

The word amputation is derived from the Latin amputare, "to cut away.

The English word "amputation" was first applied to surgery in the 17th century by Peter Lowe in 1612.

amputation of the hands, feet or other body parts is or was used as a form of punishmentfor people who committed crimes.

In some cultures and religions, minor amputations are considered as a ritual accomplishment.Amputation history

Cave-wall hand imprints have been found which demonstrate that Neolithic humans had amputated limbs.

Earliest literature discussing amputation is the Babylonian code of Hammurabi 1700 BC385 BC Plato's symposium and Hippocrates De Articularis

1st century BC cautery was used for large vessels1588 William Clove first successful AKA1674 Morel battle of Borodino tourniquet1679 Younge local flaps for wound closure (animal bladder used previously)

Amputation history

1781 John Warren 1st successful shoulder amputation1806 Walter Brashear 1st successful hip joint amputation1825 Nathan Smith described knee disarticulation1870 Stockes and Grittis procedure

1890 Jaboulay and Girard 1st successful hindquarter amputation1943 Norman Kirk guillotine procedure in WWIIAmputation history

In US 30,000 40,000 amputation are performed annually.There were 1.6 million individuals living with loss of a limb in 2005. These expected to become 3.6 million by the year 2050Male : female ratio LE = 2:1 UE = 4:1majority in the 65 - 79 year age group LE : UE ratio = 11:110% perioperative mortality3 year survival after BKA 57%; after AKA 39%

Epidemiology

Epidemiology

IndicationsAlan Apley encapsulated the indications for amputation in the three Ds:

Indications

Peripheral vascular disease ( 60 -70 % in LE )DM (90%)ArteriosclerosisThromboembolismSevere traumatized limb ( 75 80 % in UE)Burns Frostbite

1DDead or dying limb

Indications

Malignant tumors Lethal sepsisCrush injury leading to crush syndrome

2DDangerous limb:

Indications

Remaining the limb is more worse than having no limb at all . Because of :-Pain Gross malformation Recurrent sepsisSevere loss of function

3DDamn nuisance

Varieties of amputations

When primary healing is unlikely The limb amputate as distal as the causal factor will allow Skin flap suture loosely over a pack Re-amputation perform when stump condition is favorable

Provisional amputation

Varieties of amputations

When weight is taken through the end of the stump The scar must not be terminal Bone end must be solid (cut near the joint)

Definitive end-bearing

Varieties of amputations

Commonest variety All upper limb & most lower limb amputations are come under this type The scar can be terminal

Definitive non-end-bearing

Wagner et al (Journal of vascular surgery 1988):[ clinical judgment is superior to objective assessments. More distal amputations can be achieved with clinical measures over objective studies.]

Clinical judgment is central to amputation level selection.

Level Selection

skin quality, extent of ischemia/ infectionpresence of a pulse immediately above the level of amputation almost 100% chance of healing

joint- and residual-limb-length salvage is directly correlated with functional outcome

Short stump slips out from the prosthesis Long stump pain, ulceration, incorporate of the joint in the prosthesis Now a day the skill of prosthetist make amputation possible at any level

Level SelectionSubjective measuresClinical examinationLocal functionProsthetic design

Doppler Ultrasound pressures Skin perfusion pressurestranscutaneous oximetry

angiography

Level SelectionInvasive proceduresNon-invasive proceduresObjective tests

Doppler ultrasound pressures maybe unreliable in diabetics ankle pressures >60mm --->50% chance of BKA healing

Skin perfusion pressures Radio isotope washout Laser doppler velocimetry