Lesson 3 Levels of Amputation.ppt
- 1. Surgical Procedure levels of amputation
- 2. Lower Extremity Amputation • The major cause of lower extremity amputation is peripheral vascular disease (PVD), particularly when associated with smoking and diabetes • The second leading cause of amputation is trauma, usually from motor vehicle accidents or gunshot • The incidence of amputation from osteogenic sarcoma has been reduced by better limb salvage
- 3. Selection of Amputation Levels • PVD - Failed revascularisation - Extensive tissue loss - Unreconstructable - Excess surgical risk
- 4. Selection of Amputation Levels • Diabetes - Overwhelming sepsis - Extensive tissue loss - Excess surgical risk
- 5. Selection of Amputation Levels • Trauma - Crush - Nerve injuries • Others - Spina bifida - Contractures - Neuropathy - Bed bound
- 6. Level of Amputation • Surgeon's selection of the level of amputation is influenced by: – Viability of the good tissues’ – Prosthesis – Patients’ needs • Occupation • Cosmoses • Age and gender
- 7. Surgical Process Basic principles • The surgeon’s goal is to amputate at the lowest possible level compatible with healing • Skin flaps are as broad as possible which depend on the causes: • Dysvascular or non-dysvascular. • The scar should be pliable, painless, and nonadherent.
- 8. Non-dysvascular • For most transfemoral and non-dysvascular transtibial amputations, equal length anterior and posterior flaps are used, placing the scar at the distal end.
- 9. Dysvascular • Long posterior flaps are often used in dysvascular transtibial amputations
- 10. Healing Process • Factors that may affect healing include – Infection, – Cigarette smoking, – The severity of vascular problems, – Diabetes, – Renal disease, – Other physiological problems such as cardiac disease
- 11. The Major Outcomes of the Postsurgical Period 1. Promote as high a level of independent function as possible 2. Guide the development of necessary physical and emotional level for eventual prosthetic rehabilitation 3. Independence in mobility and self-care 4. Independence in bed mobility and basic transfers 5. Supervised or independent mobility with crutches or walker 6. Demonstrate knowledge of proper residual limb positioning, bandaging, and care
- 12. The Major Outcomes of the Postsurgical Program 1. Reduce postoperative edema and promote healing of the residual limb 2. Prevent contractures and other complications 3. Maintain or regain strength in the affected lower limb 4. Maintain or increase strength in the remaining extremities 5. Assist with adjustment to the loss of a body part 6. Demonstrate knowledge of basic residual limb exercise 7. Learn proper care of the remaining extremity 8. Determine the feasibility of prosthetic fitting
- 14. Conclusions • Amputation is traumatic enough…poor level selection can make it worse. • Clinical judgement central to proper level selection • Patient factors are more important than objective testing
- 15. Levels of lower Limb Amputation .
- 17. Rehab Outcome and Level of amputation • The level of amputation and age of patient affect the outcome • Higher the amputation, more difficult the rehab. • Older/sicker the pt., more difficult the rehab.
- 18. Levels of Lower Limb Amputation Lower Extremities > 90% • Trans-pelvic amputation • Hip disarticulation 1% • Transfemoral (AK) 32% • Knee disarticulation (KD) • Transtibial (BK) 54% • Syme/foot 3% Upper extremity 8% • Forequarter • Transcarpal • Shoulder disarticulation • Transhumeral • Elbow disarticulation • Transradial • Wrist disarticulation
- 19. Trans-pelvic amputation Hind quarter amputation (hemipelvectomy) • Removing of the entire limb and part of ileum, pubis, ischium and sacrum and leaving peritoneum muscles and fascia to cover and support the internal organs. • It’s a save life procedure.
- 20. Hip disarticulation (HD) • Amputation of the lower limb at the hip joint, leaving the pelvis intact. • Mainly due to tumor and rarely because of vascular disease.
- 21. Trans-femoral amputation: above-knee amputation (AK) • Amputation of the lower limb between the hip joint and the knee joint. • Surgeons must leave 11.5-12.5 Cm • Long stump tend to flex and adduct. • Short stump tend to flex and abduct.
- 22. Knee disarticulation (KD) Gritti-Stokes Amputation • Amputation of the lower limb at the knee joint. • An excellent weight-bearing stump. • It is most often used in children and young adults, but is nearly always avoided in the elderly and patient with ischemic disease. • Advantages include: – A large end surface covered by skin and soft tissues that is naturally suited for weight bearing. – A long lever arm controlled by strong muscles. – Increased stability of the patients prosthesis. • Disadvantage – Cosmetic (longer artificial leg)
- 23. Below Knee Amputation (BK) • The ideal level for amputation in the BKA patient is approximately at the mid-calf. – The distal third relative avascularity and lack of sufficient soft tissue padding at this level. • The ideal BKA stump in adults is 12.5 to 17.5cm.
- 24. The Symes amputation • Disarticulation at the ankle joint and removal of the medial and lateral malleoli to the level of articular surface of the tibia. The heal pad being sutured into the position over the distal end of the tibia and fibula. • it creates an excellent end- bearing stump and allows for a functionally most satisfactory prosthesis. • Problems include posterior migration of the heel pad, and a bulky non-cosmetically pleasing prosthesis.
- 25. the Chopart amputation • Disarticulation of the talus bone and the rest of the tarsus bones.
- 26. Lisfranc’s Amputation • Disarticulation between tarsus and metatarsus bones. Or • Amputations proximal to the transmetatarsal level.
- 27. Transmetatarsal Amputation • Amputation through the metatarsal bone.
- 28. Ray Amputation • A ray amputation is a particular form of minor amputation where a toe and part of the corresponding metatarsal bone is removed.
- 29. Toes Amputation • the fifth toe (the most commonly amputated toe) is usually removed for being overriding on the fourth toe. • Complications of toe amputations with regards to gait are minimal. • This is true for amputation of the great toe during standing or walking at a normal pace. However, if the patient walks rapidly a limp appears from the loss of the normal push-off provided by the great toe. • Additional complications specific to the toes include a severe hallux valgus deformity seen in amputations of the second toe.