Amputation- Types of Amputations & Pt Management
Amputation can be defined as process of removal of diseased, non functioning, protruding body part
Delivered from Latin word AMPITUDE meaning “cutting around”.
Age: Commom in 50-75 years
Sex: Males (75%)
Limbs: Lower limb(85%)
Most commonly in young patient less than 50 years of age: Trauma due to Road traffic accident, industrial accidents etc.
More than 50 years: Disease like buerger’s disease, diabetes, artherosclerosis etc.
Less commom causes
Infections,Malignancy, Nerve injuries, & Severe cold or heat
1. Level of amputation:
• More distal level of amputation leads to more complications. But stump are functionally better.
• More proximal level of amputation leads to less complication. But results in functionally poor stumps
2. Torniquet: is used except in severely ischemic limb
3. Muscle dissection should be at least 5cm away from bony landmark. They are further stabilised by :
• Myodesis suturing muscles and tendons to the bone
• Myoplasty suturing muscle to periosteum
4. Skin flap should be of full thickness and dissection between tissues plain should be avoided to prevent further devascularisation of tissue.
5. Blood vessels Major blood vessels should be isolated and individually livated.
6. Nerve should be isolated gently pulled out and cut to prevent retraction from cutted part.
7. Bone should be terminated and rasped for smoother contour. Excessive periosteum stripping should be avoided to reduce regeneration of overgrowth.
8. Post operative:
• Rigid dressing: Reduce edema at site
-Improve wound healing.
-Early stump maturation.
• Rehabilitation: Begin as soon as possible
-Balance and coordination exercise for gait training.
1. Poor circulation- POVD, Diabetes
• Trauma= 3/5 structures grossly and irreversibly injured.
• Crush injury
• Frost bite
3. Infections- Osteomyelitis, Infected mal-unions, Infectious trophic ulcer.
5. Gross mall formation
6. Congenital anomalies- particularly in children it is the main indication of amputation.
1. Closed Amputation: In this type of amputation flaps are fashioned and are closed primarily along with surgery.
2. Open Amputation: In this type of amputation flaps are not closed properly. Later revised amputation , Re-amputation, or Plastic repair is done.
Guillotine technique– Here all the tissues are cut at the same level . In severe crush injuries types & severe Infections this technique is used.
Other types includes:
• Revision amputation for ideal stumps.
• Early Amputation.
• Immediate Amputation.
• Late Amputation.
1. Phantom limbs:
• Some amputees experience the phenomena of phantom limbs, they feel body part that are no longer there.
• Limbs can ich, ache and feel if they are moving.
• Scientists say that it happens due to neural map that send information to brain about limbs regardless their existence.
6. Painful neuromas
7. New bone formation at amputation sites
8. Hyperthesia of stumps.
Physiotherapy management in amputations
Management of the stump
Edema of the stump is a trouble have some problem & can be contain.
1. Limb should be kept elevated with elastocrepe bandage.
2. All the joints including the stump are subjected to resistive exercises.
3. Stump bandaging is an art & a skill, very useful in preventing the edema.
• A 6 inches elastic bandage for the lower limb & 4 inches for the upper limb.
• B andage should be applied with optimum pressure
• During exercise bandage should be taken off.
• Circular turns leads to a tourniquet effects chocking the stumps, hence diagnosed, oblique or spiral turns should be used.
• In above knee amputations, it should be extended up to the groin and the hip should be in extension & adduction.
• The below knee stump should be in flexions. Methods of below knee stump bandaging.
• 85% amputations are through the lower limbs.
• Level of amputation is no longer imp due to effiecient prosthesis.
• Severe injury forms the most common indications.
• The latest concept is to preserves as much stump length as possible.
• Guillotine amputations are procedures for life- threatening infections.
• Stump care is very vital to prevent post amputation problems.