Limb amputation

Limb amputation . It is the removal of a limb or part of it accompanied by the interruption of the continuity of 1 or more bones. The division of the limb between the bones that form a joint is designated by the name of disarticulation. The remaining segment is called a stump.

Summary

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• 1 Classification
• 2 Indications
• 3 Contraindications
• 4 Technique
  • 1 Preoperative indications
  • 2 Technical details
• 5 Postoperative recovery time
• 6 Source

Classification

It is classified in:

• Considering its magnitude.

1. Major amputations: are those that interfere with balance and stability ( thighand leg ).
2. Minor amputations: are those that alternate little balance and stability (1/3 anterior foot, toes , etc.).

• Considering the presence or not of sepsisin the limb to be amputated.

1. Closed amputations: they are performed in patients considered to be uninfected.
2. Open aputations: they are practiced in patients considered to be infected.

Indications

Amputation will be indicated when there is an injury to an extremity that endangers, in the first place, the rest of this and later, the life of the patient, as well as in patients with significant deformations of the limbs.

Contraindications

In those patients who show a deplorable general state and in whom the surgical risk is greater than the disease of the limb itself if it is allowed to evolve.

Technique

Preoperative indications

• Comply with general rules of the preoperative period.
• Properly sedate the patient, from days before.
• Explain to family members the risk and type of operation to be performed.
• Prepare the patient psychically (very important).
• Administer evacuating enemas(at 10 pm).
• Metabolicallycontrol diabetic patients .
• Administer liquid diet the night before the operation.
• Shave the limb to be amputated.
• Wash with water, soap and brush tip.
• Apply antiseptic solution.
• Isolate by covering with dressing and gauze the areas to be removed.
• In those patients who, due to their precarious general condition, it is necessary to defer the operation, the extremity may be frozen.

Technical details

Closed amputations:

• Optimal level of amputation: As much tissue as possible should be saved. The best level in the thigh is the union of the middle and lower third; in the leg, the junction of the upper and middle third, and, in the foot, the transmetatarsal amputation. Levels 10 cm – 12 cm above the wrist joint in the forearm, and the lower third of the humerus , in the arm are recommended .
• The flaps must be well nourished (adequate color, temperature and bleeding):

1. These should not be left voltage or redundant.
2. At the 3 amputation levels, it is best that the anterior flap be short and the posterior flap long, for nutritional reasons.

• Soft tissue division:

1. The muscles: they must be treated with care, they must not include much muscle tissue, the ligatures of the vessels. They must be sectioned with a well sharpened instrument.
2. The nerve: it must be sectioned with a well-sharpened instrument, it must be tied with chrome catgut No.0, it must not be traumatized or pulled, it is not necessary to infiltrate with novocaine.
3. The trunk vessels.
4. Small glasses.

• Bone Sawing:

1. These should be sawn above the muscle-fascia section.
2. They should not be too rough (no more than 1 cm).
3. Remove bony prominences.

• Close by plans:

1. Cover the bone with the muscles well.
2. Closure of the anterior and posterior muscle planes, facing them with chrome catgut No.0.
3. Closure of the fascia (optional) with chrome catgut No.0.
4. Skin closure with silk No.0.
5. Sterile bandage and gauze application.

• Drains: should be avoided in patients with arterial insufficiency.
• Rehabilitation:

1. Immediate: immediate prosthesis application is ideal, as long as the general condition of the patient and local stump conditions allow. the provisional prosthesis is placed on the same operating table.
2. Mediate or late: depending on what has been previously indicated, elastic bandages and bandages must be placed on the stump, practice exercises from the day after the operation, lift the patient and make him walk with crutches or between bars, remove the alternate points to the 7 days and the rest at 12 days – 14 days, place the provisional prosthesis and apply adequate physiotherapy and definitive rehabilitation by specialized personnel.

Open amputations.

• Incise the skinwith flaps longer than the muscle-fascia plane.
• From the muscle-fascia section in the most proximal plane possible with respect to the skin flap.
• Well proximal sawing of bones.
• Proper treatment of the nervous package.
• Apply correct hemostasis. Tourniquetscan be used in patients who have not had ischemia or urgent operations .
• Take a sample for antibiogramif secretions occur (more frequent in diabetics).
• Thoroughly wash exposed surfaces with antiseptic solutions and hydrogen peroxide.
• Cover with gauze pad (at the discretion of the doctor) and apply sterile dressings.
• Subsequently apply antibiotic therapy and care in the room.
• Irrigate with antiseptic solutions (if required).
• Discover the operative wound the next day and carry out daily healing of the stump (mainly in diabetic patients).
• Achieve healing by 2nd intention.
• Re-amputate or apply stump plasty (skin grafts may be performed).
• Rehabilitation by specialized personnel.

Postoperative recovery time

• Thirty days after final discharge for minor amputations.
• In major amputations, according to the degree of rehabilitation achieved and the profession or employment of the patient. The withdrawal or expertise of this can be assessed.