What is Amputation?
Amputation is the procedure through which a body part is cut through a bone, it should not be confused with disarticulation where part/ limb is removed through a joint.
what are the indications of amputation?
injury, peripheral vascular disease, congenital, gangrene, infections, nerve injuries, tumours.
Types of amputation?
open type: where skin is not closed over stump, usually wound is not healthy, operation is followed after some time for skin grafting or reamputation is done, or plastic repair is done.
closed amputation : it is elective amputation where skin is closed to cover the stump.
surgical principles: Amputation Surgery is very important and following principles must be kept in mind.
a> torniquet: is applied
b> Exsanguination: usually a limb is squeezed by wrapping it with a stretchanble bandage (Esmarch bandage) before a tourniquet is inflated, it is contraindicated in cases of infection and malignancy.
c> the level of amputation: this is decided by type of disease, joint is always tried to save, suitability for the efficient functioning of artificial limb.
Skin Flaps over stumps should be mobile, and normally sensitive.
Muscles should be cut distal to the level of bone and suturing is done as myoplasty (opposite group are sutured to each other), myodesis ( muscles are sutured to end of stump).
Nerves are gently pulled distally into wound, divided by a sharp knife so that cut end retracts well proximal to the level of bone section.
Major blood vessels should be doubly ligated and left as such.
Bone edges should be made smooth.
After amputation soft dressing or rigid dressing is done (prefered).
Complications:
Hematoma, infections, skin flap necrosis, deformities of joint, neuroma and phantom sensation.
Phantom sensation: is the sensation as if amputated part is still present, phantom pain is the awareness of pain in amutated limb, its treatment is difficult.
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