Types of amputation:
- Minor amputation
- Major amputation
Major amputation - is the one where part of the leg or arm is removed. Below knee amputation (BKA), above the amputation (AKA), above the elbow (AEA), below the elbow amputation (BEA) or through elbow amputation are the good examples of this type.
Indications :
1. Congenital limb deficiency - when the limb is grossly deformed and useless.
2. Vascular insufficient - in case of ischemic necrosis of the limb, diabetic foot ulcer, peripheral vascular diseases and acute inflammation and thrombosis of the arteries and veins in smoker, severe trauma beyond the repair and other many.
3. Chronic osteomylitis
4. Tumor- malignant
5.Trauma- crush injuries to the limbs
The goal of amputation is to preserve all possible length especially in the upper limbs depends on the level of pathology.
This rule may not apply much in lower limb, but at least the knee should be saved if possible for functional advantage.
- During amputation of leg, anterior margin of the tibia is often beveled, enough tissues with a good blood supply to it is provided by a longer posterior flap.
- Below knee amputation should not be longer than 20cm, because it may interfere with healing process.
Types of Flaps.
1. Fish mouth - commonly used when amputation above the knee.
2. Long posterior flap - commonly used when amputation below the knee.
Procedure.
- arteries should be tied individual, and nerves should be at higher level as possible.
- enough soft tissues but not excessive amounts should be remain to covered the area.
- cut nerves should be away from pressure area and from scar to avoid neuromas symptoms When pressure is applied.
-the bone cut should be at high level and sharp margin should be cut.
Complications.:
-pressure sores
-infection of the wound
-failure of the wound to heal
-contractures of the knee or hip joint
-deep venous thrombosis in the leg
-phantom limb pain.
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