Blood vessel disorders such as atherosclerosis, often secondary to diabetes mellitus, account for the greatest percentage of amputations of the lower limb. Pain after amputation bja education oxford academic. In those times, surgical amputation was a crude procedure by which a limb was rapidly severed from an unanesthetized patient. The transfemoral amputation level, part 2 surgery and. It plays a small part in hip movement, but chiefly is involved in knee movement. Amputation occurs at any level between the knee and the ankle. If the above considerations rule out a transtibial amputation, a knee disarticulation may be considered. Low aboveknee amputations are used for bone sarcomas of the leg, especially those involving the popliteal fossa or arterial trifurcation. The indications for an aboveknee amputation include doubtful prospect of healing. Amputation is the intentional surgical removal of a limb or body part.
A bk amputation allows saving the knee and usually some part of the tibia bone that goes down to the foot. General principles of amputation surgery uw orthopaedics. Get a printable copy pdf file of the complete article 573k, or click on a page image below to browse page by page. An abovetheknee amputation aka is the surgical removal of the leg above the knee. The clinical and surgical considerations surrounding aboveknee amputations, as well as details of the surgical technique, are described in this chapter. Amputation is the most ancient of all surgical procedures.
The transfemoral amputation level, part 2 amputee coalition. The most common indication for amputation of an upper limb is severe trauma. Surgical proceduresamputation wikibooks, open books for. Amputation of a hand or foot was a common punishment in many of the older socalled civilized societies and is still carried out today in. This resulted in a belowknee amputation instead of an aboveknee amputation that was originally planned. The transfemoral amputation level, part 1 amputee coalition. An amputation is performed as far above the affected area as is necessary to remove all unhealthy tissue and to leave a. It is performed to remove diseased tissue or relieve pain or due to trauma. There was a discrepancy in findings of physical examination and dus of 25% and 64% of femoral and popliteal pulsations respectively.
Throughknee amputation is a feasible alternative to above. The preferred incision during a knee disarticulation extends from the attachment of the ligamentum. Amputations through the knee joint or just above the knee joint grittistokes amputation can also sometimes be performed. The operation of the below knee amputation is sadly not an infrequent operation in the foot and ankle surgical world. This article will focus on surgery and postoperative management. Comfort silver liner stump sheath, antiodor, antimicrobial, 2 sheaths. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. For abovekneeamputations aka flexion and abduction. Transfemoral aboveknee amputation or aka, transtibial belowknee. The patient should be independent with the exercise program and also understand. Learn the below knee amputation surgical technique with step by step instructions on orthoracle. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free.
Fathi aboveknee amputations may be performed through the distal femur supracondylar the midfemur diaphyseal, or just below the lesser trochanter high aboveknee amputation tumors of the distal femur high aboveknee amputation tumors of the leg standard aboveknee amputation surgical technique the patient is supine, and the operated extremity should be. Get a printable copy pdf file of the complete article 664k, or click on a page image below to browse page by page. Amputations above and below the knee are common surgical procedures performed by vascular, orthopedic, and general surgeons. Amputation is a blind and final method in surgery to save the patients life. A rotator unit can still be used on a long transfemoral amputation, but the knee center on the amputated leg will then be lower than the opposite knee center. Surgical revision for stump problems after traumatic above.
Below knee amputation an overview sciencedirect topics. The apex of the skin flap is marked on the lateral side of. The technique, results, and fol lowup are described. Amputation is a surgical and reconstructive procedure that is a last resort. Aboveknee amputations may be performed through the distal aspect of the femur supracondylar, the middle section of the femur diaphyseal, or just below the lesser trochanter high aboveknee. Duplex ultrasound may predict the best level of lower limb. The lower leg will also be shorter than the opposite leg. Many patients have only marginal blood supply and the utmost surgical care and technique is required to maximize their wound healing potential. After the amputation 6 transfemoral above knee manual a recommended approach everyone reacts to an amputation differently. The term for the surgical technique to reattach muscles to. Our elearning platform contains high resolution images and a certified cme of the below knee amputation surgical procedure. Below knee amputation 2 surgery video general surgery video.
Just as plastic surgical techniques are required in operating on the hand and foot, the same techniques of gentleness in skin and other tissue handling are applicable to amputation surgery. Amputation is the removal of a body extremity by trauma or surgery. Amputation is one of the oldest surgical procedures with artificial limbs. One surgical technique to use for knee disarticulation amputation is with equal sagittal flaps after kjolbye starting anteriorly above the tibial tubercle and. Below knee amputation surgical technique orthoracle.
Aboveknee amputation technique download here free healthcaremagic app to ask a doctor all the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Above knee amputation technique tips and tricks from doctors. Patients who underwent above knee aka or below knee amputation bka from 2005 to 2010 were identified from the american college of surgeons national surgical quality improvement program acs. Comfort regal prosthetic socks, comfortable and durable, fleeced interior. Unlike individuals with a knee disarticulation, a person with a transfemoral amputation can no longer take the bodys weight directly on the transected end of the limb. This creates a situation similar to many knee disarticulation patients. We have analyzed the association of multiple clinical factors with the morbidity of 1028 consecutive amputations performed in 786 patients during a year period. The conventional, constant friction knee joint used in most above. Above knee amputation below knee amputation midfoot amputation. Although various techniques to determine amputation level have become available, obvious clinical factors may yet identify patients in whom a major amputation is unlikely to heal. Increase muscle strength, so you can move more easily on your own.
Woodburn mb chb, md frcsg gen, benjamin lindsey mb bs, frcse, in comprehensive vascular and endovascular surgery second edition, 2009. Amputation is at the hip joint with the entire leg removed. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. This will also allow the prostheses to be less complex and more functional because the entire knee joint is not part of the prosthesis.
Amputations can be either planned or emergency procedures. Amputation occurs at any level between the hip and knee joints. As with all surgery, careful judgement is necessary in the selection of suture and closure technique, and the amputation surgeon must be aware of the options and differences between various techniques. When viewed in this light, the amputation becomes a surgical challenge instead of a.
Aboveknee and belowknee amputation basicmedical key. Low above knee amputations are used for bone sarcomas of the leg, especially those involving the popliteal fossa or arterial trifurcation. Ideal location is between 12 cm above knee joint and 18 cm below greater trochanter, less than 5 cm distal to lesser trochanter apex of incision at the level of the bony resection anterior flap 2. Types of lower extremity amputation and considerations. Injury and arterial embolisms are the main reasons for emergency amputations. Aboveknee amputation and hip disarticulation thoracic key. Above the knee amputation discharge care what you need. How i do below knee amputation linkedin slideshare. Throughknee amputation tka is a rare amputation performed in aug 18, 2011.
The indications for an aboveknee amputation include doubtful prospect of healing at the transtibial level, low likelihood of mobilization, and fixed flexion deformity at the knee. In manual of surgical pathology second edition, 2006. Higher above knee amputations are generally used for primar y bone sarcomas of the distal femur. Full text is available as a scanned copy of the original print version. Total hip replacement in an ipsilateral abovetheknee. Surgical amputation is currently performed in cases of bone and tissue cancers, gangrene, and uncontrollable infections of the arm or leg. Higher aboveknee amputations are generally used for primar y bone sarcomas of the distal femur. The surgical technique is simple and nontraumatic since no bone or muscle tissue is to be dissected. Knee arthrodesis versus abovetheknee amputation after. The thigh muscles are completely preserved and thus there. Conversion rates increased with a more proximal occlusion on dus. Reasons for an aka include poor blood flow which cannot be corrected resulting in tissue loss or extreme pain, severe infection, trauma or injury, tumor or congenital disorder. The indications for these procedures include infection, acute ischemia, chronic progressive ischemia, trauma, intractable pain, neuropathy, and. Guinard, in 1901, attempted in a similar case to remove thrombus in an artery with a long clamp, and martin noted the restoration of collateral circulation in those.
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