Amputations of the lower extremity
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Transcript of Amputations of the lower extremity
AMPUTATIONS OF THE LOWER EXTREMITYNguyen Quang Ton Quyen
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSFEMORAL (ABOVE-KNEE) AMPUTATIONS
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
Short
Standard
Long
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
ischemic nonischemic
NONISCHEMIC LIMBS
• The level of amputation• Lever arm and circulation• Cause
• Ideal bone length: 12.5 to 17.5 cm• Rule: 2.5 cm/30 cm
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
0.6 cm - bone section
1.2 cm proximally
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
- control edema - limit knee contracture - protect the limb
AMPUTATION OSTEOPLASTY
• Ertl procedure
AMPUTATION OSTEOPLASTY
• Stops tib/fib motion - may lead to less pain• Provides broader distal bone surface - may
increase end bearing• Periosteal Flap used to cover end of tib and fib -
more normal intra-osseous pressure
• Improved outcomes have not been proven
ISCHEMIC LIMBS
• Blood supply better on the posterior and medial aspects• Performed at a higher level• Procedure of Ertl is contraindicated• Tourniquet
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
POSTOPERATIVE CARE
• Some areas may be tighter than others
• Become loose quickly
POSTOPERATIVE CARE
• Rigid dressing is preferred
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
TRANSFEMORAL (ABOVE-KNEE) AMPUTATIONS
Short
Medial
Long
TRANSTIBIAL (BELOW-KNEE) AMPUTATIONS
•Surgeons completely understand •surgical principles•postoperative care•prosthetic design
•Use diagonal turn•Graduate the pressure•Promote a conical shape•Anchor the bandage
socket
knee
pylon
foot
$80