Amputation

 



Introduction 

Amputation - Removal of the distal part of the distal part of the extremity by length.

Disarticulation - removal of the distal part of the extremity at the level of joint.


Indicators
  
Absolute - crushing of the tissue
                - massive or gas gangrene
                - 3rd and 4th degrees of the burnt or frozen tissue
Relative - chronic infection; such as osteomyelitis, tuberculosis, septic arthritis
               - malignant tumour of the bone, such as osteosarcoma
               - Trophic ulcer
               - congenital or acquired limb deformity
              - chronic vascular insufficiency of the extremities

Classifications of amputations


Clinical classification by Burdenko according to time:


(i) early amputations -  It may be primary or secondary
(ii) primary or urgent amputation: performed durning the first 24 hours.
(iii) Secondary or emergency amputation: performed during from the 1st day to 7th or 8th day.
(iv) late or elective amputations: don't have specific time of performing may be performed at any            time, every month or year.
(v) repeated amputation or reamputation: performed in postoperative complications.


Anatomical classification according to shape of the cut tissue:


(i)  Guillotine amputation or open amputation: 



most primitive type of amputation. 

(ii) circular amputation: 



the method divided into one stage, two stage, three stage amputation

(iii) amputation by using flaps: 


the method divided into one flap, two flap, three flap, and multiple flap amputation.

(iv) amputation using by elliptical incision

(v) Amputation using by racquet incision 


According to tissue used to cover the bone saw line:



1. Fasciocutaneoplastic method
2. Fasicoplastic method
3. Tendenoplastic method
4. Myoplastic method
5. Fasicoperiosteoplastic method
6. Osteoplastic method

Stages of amputation and disarticulation:


A) dissection of the skin
B) cutting the soft tissue of the extremities
C) ligature of the vessels
D) cutting the periosteum
E) cutting the bone
F) cutting the nerve
G) stump formation


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Reference

Text reference book
Topographic anatomy and operative surgery by professor T.A. Fominykh - first edition