Amputation is of the common surgical procedure done in the ER. This is also common in various routine cases. This presentation covers various aspects of amputation including steps of below knee amputation. The background has been changed from the previous one to hide the brutality of this procedure.

1. Amputation Dr. Muhammad shahiduzzaman Professor and Head Orthopaedics and Traumatology Dhaka Medical College hospital

2. Derived from the Latin amputare. "to cut away", from ambi- ("about", "around") and putare ("to prune"). Amputation is the complete removal of an injured or deformed body part. The English word "amputation" was first applied to surgery in the 17th century. Amputation Nomenclature.

3. History Most ancient of surgical procedure. Historically were stimulated by the aftermath of war. It was a crude procedure by which limb was rapidly severed from unanesthetized patient. The open stamp was then crushed or dipped in boiling oil to obtain hemostasis. Hippocrates was the first to use ligature. Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis. Amputation

4. Condition leading to amputation Trauma Burns Peripheral Vascular Disease Malignant Tumors Neurologic Conditions Infections Congenital Deformities Amputation

5. ‘DDD’ Dead Deadly Dam Nuisance Amputation Indications:

6. Amputation Trauma

7. Amputation Malignant Tumor

8. Amputation Gangrene

9. Crush Amputation

10. Peripheral Vascular Disease Amputation

11. Congenial Anomaly Polydactyly Amputation

12. Scleroderma Amputation

13. Determination of level Zone of Injury (trauma) Adequate margins (tumor) Adequate circulation (vascular disease) Soft tissue envelope Bone and joint condition Control of infection Nutritional status Amputation

14. Level of Amputation

15. Debridement of all Nonviable tissue and foreign material Several debridements may be required Primary wound closure often contraindicated High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viable Techniques Amputation

16. Nerve Prevent neuroma formation Draw nerve distally, section it, allow it to retract proximally Skin Opportunistic flaps Rotation flaps Tension free Skin grafts Techniques Amputation

17. Techniques Bone: Choose appropriate level Smooth edges of bone Narrow metaphyseal flare for some disarticulations Postoperative Dressing: Soft Rigid Amputation

18. Goals of Postoperative Management Prompt, uncomplicated wound healing Control of edema Control of Postoperative pain Prevention of joint contractures Rapid rehabilitation Techniques Amputation

19. Below Knee Amputation

21. Skin Flaps: Combined length must be 1.5X width.

22. Muscles are divided distal to the proposed site of bone section.

23. Myodesis: opposing groups are sutured over the bone end to each other and with the periosteum.

25. BK Amputations:Post operative follow up after 14 days Amputation

26. Techniques… Few examples Amputation

27. Techniques… Few examples Amputation

28. Techniques… Few examples After 12 months Amputation

29. Rehabilitation and Prosthetics Amputation

30. Rehabilitations. Amputation 1. Residual Limb Shrinkage and Shaping 2. Limb Desensitization 3. Maintain joint range of motion 4. Strengthen residual limb 5. Maximize Self reliance 6. Patient education: Future goals and prosthetic options

31. Psychological stress. Amputation Up to 2/3 of amputees will manifest postoperative psychiatric symptoms Depression Anxiety Crying spells Insomnia Loss of appetite Suicidal ideation

32. Prosthetics Amputation

33. Management of Amputee Preparation Good Surgical Technique Rehabilitation Early Prosthetic Fitting Team Approach Vocational and Activity Rehabilitation Amputation

34. Thank You