AMPUTATION orthopedic surgery augustus.pptx

Amputation
Orthopedic surgery

1. AMPUTATION ONYEMESIM AUGUSTUS

2. OUTLINE Introduction History Epidemiology Aetiology Indication Types Surgical Techniques Signs and symptoms Investigations Post op management Complications Conclusion

3. INTRODUCTION Amputation is the surgical removal of a limb or a part of a limb, usually as a result of injury, disease, or congenital condition. It is a complex and multifaceted surgical procedure that requires careful consideration of indications, surgical techniques, and postoperative care. It could also be the severance of a limb or part of a limb through a bone or multiple bones The removal of a whole limb or part of a limb through a joint is called Disarticulation .

4. HISTORY Amputation is derived from the latin word " amputare " which means cutting around. The English word "amputation" was first applied to surgery in the 17th century . Amputation has been performed for thousands of years, with evidence of ancient civilizations such as the Egyptians and Greeks performing amputations. Over time, surgical techniques and prosthetic devices have evolved significantly, improving outcomes and quality of life for individuals with amputations.

5. EPIDEMIOLOGY According to a study published in the African Health Sciences journal, the prevalence of amputation in Nigeria is significant, with trauma being the leading cause, followed by diabetic foot gangrene . The study found that the majority of amputations (84.8%) were performed on the lower limb, while 15.2% were performed on the upper limb. Amputation is commoner in males than females.

6. AETIOLOGY The primary causes of amputation include: Trauma: Industrial and motor vehicle accidents can lead to traumatic limb loss.(leading cause in Nigeria) Peripheral vascular disease (PVD): The leading indication for limb amputation in the United States, primarily in elderly persons with diabetes mellitus.(2 nd leading cause in nigeria )

7. Tumors: Malignant bone tumors can require amputation. Infection : Sepsis and gangrene can necessitate amputation. Congenital limb deficiency A small percentage of amputations are performed due to congenital absence or limb malformations.

8. INDICATIONS 1.Trauma: Severe injury to a limb. 2.Infection: Severe infection, such as gangrene, to prevent the spread of infection. 3.Tumors: Malignant tumors, such as osteosarcoma . 4.Vascular disease: Severe peripheral artery disease (PAD) may require amputation. 5.Congenital conditions: Certain congenital conditions like fibular hemimelia .

9. TYPES OF AMPUTATIONS UPPER LIMB AMPUTATIONS Forequarter amputation : Removal of the entire arm, including the shoulder joint. Shoulder disarticulation : Removal of the arm at the shoulder joint. Transhumeral amputation : Removal of the arm below the elbow. Transradial amputation : Removal of the arm below the wrist.

10. TYPES OF AMPUTATIONS LOWER LIMB AMPUTATIONS Hemipelvectomy : Removal of the entire leg, including the hip joint. Hip disarticulation : Removal of the leg at the hip joint. Transfemoral amputation: Removal of the leg below the knee. Transtibial amputation: Removal of the leg below the ankle.

11. SURGICAL TECHNIQUE 1.Guillotine amputation : A rapid and simple technique used in emergency situations in severely infected limb. 2.Open amputation: A more controlled technique used in elective situations. The stump is not closed with skin flap immediately rather it is left open allowing the wound to drain as soon as infection is completely eradicated, the stump is then closed.

12. SURGICAL TECHNIQUE 3.Closed amputation: A technique used in situations where the amputation is performed at a site with minimal tissue damage. Here, the stump is closed with the flap of the skin and sutured.

13. PRINCIPLES Tourniquet - is used except in ischaemic limb Skin - should be large enough for muscle coverage and tension free closure Muscles - are sutured to the periosteum in myodesis or to opposing muscle groups in myoplasty Nerves - are transected proximal to the cut end of the bone Blood vessels - major vessels are double ligated and cut while small vessels are coagulated.the tourniquet is then released and hemostasis is complete Bone - is cut down perpendicularly with a gigli/bone saw proximal to muscle section Drains - used and removed 48 - 72 hours after surgery

14. Early Signs and Symptoms Infection: Redness, swelling, warmth, and drainage from the amputation site. Wound dehiscence: Opening of the wound edges. Flap necrosis: Death of the skin flap. Nerve damage: Numbness, tingling, or weakness in the affected limb. Phantom limb pain: Pain perceived in the missing limb.

15. Late Signs and Symptoms Chronic pain: Ongoing pain at the amputation site. Stump pain: Pain at the amputation site due to bone spurs or nerve damage. Prosthetic complications: Problems with the prosthetic device, such as skin irritation or pain. Psychological complications: Depression, anxiety, or post-traumatic stress disorder (PTSD). Social complications: Social isolation or stigma

16. Neurological Signs and Symptoms: Numbness or tingling, Weakness, Paresthesia , Hyperesthesia (Increased sensitivity ). Psychological Signs and Symptoms:  Depression, Anxiety, Post-traumatic stress disorder (PTSD) & Body image disturbance.

17. INVESTIGATIONS. Pre-Amputation Investigations Imaging studies: X-rays, CT scans, or MRI scans to evaluate the extent of injury or disease. Angiography: To assess blood flow to the affected limb. Laboratory tests: Blood tests to evaluate electrolyte levels, kidney function, and full blood counts. Neurological examination*: To assess nerve function and sensation in the affected limb

18. INVESTIGATIONS. Post-Amputation Investigations  Wound swabs*: To assess for infection and guide antibiotic therapy. Imaging studies*: X-rays, CT scans, or MRI scans to evaluate the amputation site and surrounding tissues. Laboratory tests*: Blood tests to monitor electrolyte levels, kidney function, and blood counts. Pain assessment*: To evaluate the level of pain and guide pain management. (Phantom limb pain*: Pain perceived in the missing limb)

19. POST-OP MANAGEMENT PAIN MANAGEMENT Pain management: Multimodal analgesia, including opioids , NSAIDs, and regional anesthesia. Wound care: Debridement, dressing changes, and antibiotic therapy as needed. Rehabilitation: Early mobilization, physical therapy, and occupational therapy to promote functional recovery. Prosthetics and Rehabilitation: Customized prosthetic fitting to promote functional recovery.

20. POST-OP MANAGEMENT Elevation of the limb for 1 or 2 hours, 2 - 3 times each day to reduce local edema thereby limiting pain. Compressive elastic bandages can be worn on the stump to control swelling Mechanical stimulation, including massage, tapping reduces local limb sensitivity. Ultrasound, warm compresses, ice packs, and TENS ( transcutaneous electrical nerve stimulation) are also very useful in managing residual pain.

21. PSYCHOLOGICAL SUPPORT - should be offered by therapists,family members and support groups to help in adjusting to the new reality.

22. COMPLICATIONS EARLY Hematoma Haemorrhage Infection Flap necrosis Wound dehiscence Deep vein thrombosis Pulmonary embolism

23. COMPLICATIONS LATE Joint stiffness Phantom limb Phantom pain Depression Suicidal ideation Disuse atrophy

24. CONCLUSION Amputation is a complex and multifaceted surgical procedure that requires careful consideration of indications, surgical techniques, and postoperative care. A comprehensive approach to amputation, including prosthetic fitting and rehabilitation, is essential to promote optimal functional recovery and quality of life.

25. REFERENCES Medscape : Amputation. [Updated 2022 Feb 22]. ResearchGate : Amputation: A Review of the Literature. [Published 2020]. Browse NL. Amputation. In: Browse NL, ed. Textbook of Surgery. 2nd ed. London: Hodder Arnold; 2005: 355-365. - American Academy of Orthopaedic Surgeons (AAOS). Amputation. [Updated 2022]. - National Institute of Neurological Disorders and Stroke (NINDS). Phantom Limb Pain. [Updated 2022]. - Centers for Disease Control and Prevention (CDC). Limb Loss. [Updated 2022]. - Journal of the American Medical Association (JAMA). Amputation. [Published 2020]. - New England Journal of Medicine (NEJM). Amputation. [Published 2020] Ndukwu , Chibuzo , and Chigozie Muoneme . "Prevalence and pattern of major extremity amputation in a tertiary Hospital in Nnewi , South East Nigeria." Tropical Journal of Medical Research, vol. 18, no. 2, July-Dec. 2015, p. 104. Gale Academic OneFile , link.gale.com/apps/doc/A418181940/ AONE?u =anon~78ab0757&sid= googleScholar&xid =d9ac37af. Accessed 5 Dec. 2024.

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