What is acquired amputation?

-The loss of part or all of extremity as a direct result of trauma

or by surgery.
What is congenital amputation?
-The absence of part or all of an extremity at birth.

What is elective amputation?

-This is performed when the hand or entire limb has no
sensation and function as a result of brachial plexus injury.
What is an open amputation?
-Amputation in which the surface of the wound is not covered
with skin but left unclosed. This is done to control infection.
What is closed amputation?
-Usually a final or definitive amputation performed to create a
stump that can be used effectively with a prosthesis.

ETIOLOGY
What are the causes of amputation?
1st year of life

Congenital deficiencies

1 to 10 years of age.
Motor vehicular accidents, tumor and trauma.

10 to 20 years of age
Malignancy is the most common cause.

55 years of age
Peripheral vascular disease

Lower Extremity Amputation

The major cause of LE amputation is
peripheral vascular accident
The most common cause of PVD is
atherosclerosis
After PVD the second leading cause is
trauma
This is followed by tumors (Osteogenic
sarcoma) and last by congenital cases

Congenital Amputations
Causes:
Intrauterine development
Hereditary
Teratogenic agents
Maternal diabetes

What are the classification of

congenital amputation?

Amelia
Complete absence of the entire upper extremity or lower
extremity.

Hemimelia or Meromelia
Partial limb absence

Acheiria
Terminal transverse hemimelia, wrist level

Adactylia
Absent digit

Apodia
Absent foot

Phocomelia
Transverse total humeral radial , ulnar deficiency

Franz and ORahilly

Classification

Terminal
Complete loss of the distal end of an
extremity

Intercalary
Absence of intermediate parts with preserved
proximal and distal component of the limb.

Transverse/Horizontal
Absence of all skeletal elements distal to the
deficiency along a designed transverse axis.

Lower extremity Amputation

Above knee
Normal Length
Ischial tuberosity or the greater
trochanter to lateral tibial plateau.

Stump Length
Ischial tuberosity or the greater
trochanter to end of stump.

Below knee
Stump Length
From medial tibial plateau to end of

Normal Length
From medial tibial plateau to medial
malleolus

bone

What is a hip
disarticulation?

Hip disarticulation is the surgical

removal of the entire lower limb at the
hip level. A traditional hip disarticulation
is done by separating the ball from the
socket of the hip joint, while a modified
version retains a small portion of the
proximal (upper) femur to improve the
contours of the hip disarticulation for
sitting.

What is a transpelvic
amputation?

Transpelvic amputation is the removal of

the entire lower limb, plus a portion of
the pelvic bones. It occurs in a skeletal
zone that can include, from the socket
on the outside to the spinal column in
the middle, the acetabulum, ischium,
rami, ilium and sacrum.

What is a Lisfranc amputation?

Partial amputation of the foot at the

tarsometatarsal joint, with the sole being
preserved to make the flap. The
technique was used to treat forefoot
gangrene from frostbite. Lisfranc was
widely known for his ability to amputate
a foot in less than a minute.

What is a Syme
Amputation?

An amputation at the ankle with removal

of the malleoli and formation of a heel
flap.

What contractures are common

for lower extremity
amputations?
For below knee amputees
Knee flexion contractures
For above knee amputees
Hip abduction and flexion

What is Phantom Pain?

This is a normal sensation occurrence after
amputation of a limb. The part amputated is still
present.

What are the Types of Phantom Pain?

-Cramping (most common)

-Electric shock
-Burning
-Squeezing and wrenching

What are the Steps for

Prosthetic Management?
Preprosthetic
Pre-Operative
Operative
Post-Operative
Prosthetic Fitting and Training
Prosthetic Follow-Up Care

Preoperative
Evaluation and Assessment
Emotional Counseling
Therapy Counseling

Operative Management
The cardinal rule is to preserve as much as

length as possible.
Avoid the following level:
Hindfoot
Distal 1/3 of the leg
Supracondylar of femur

Muscles are just distal to the level of

intended bone section.
Bone must be bevelled and should be
covered with a good padding of the
tissue.
Nerves should be pulled before cutting
to retract.
Blood vessels (major blood vessels are
ligated the smaller ones are cauterized).

Skin closure
Above knee amputee-fish mouth or middle

flap.
Below knee amputee-posterior flap/anterior
suture.

Post-Operative Management
Healing of wounds
Pain control
Preparation for prosthetic fitting

Maintenance of range of motion

Independent mobility
Independent self-care

What muscles need to be

strengthened for crutch
walking?

Shoulder depressors
Shoulder adductors
Flexor, extensor and abductor of the arm
Extensor of the forearm at the elbow.
Wrist extensor
Finger and thumb flexors

Post-Operative Dressing
Rigid
Made of Plaster of Paris
Change every 5-10 days.

Advantages
Limits post-operative edema
Allows for early ambulation
Reduces length of time for shrinking

Disadvantages
Requires careful application
Requires close supervision
Does not allow early wound inspection

Semi-Rigid
The Unna Paste Dressing
A compound of zinc oxide, gelatin, glycerin
and calamine maybe applied in the operating
room.

Advantage
Better control of edema

Disadvantage
May loosen easily

Soft Dressing
Oldest method of post-surgical management

of residual limb.

Advantage
Inexpensive
Lightweight and readily available
Easily laundered

Disadvantage

Poor control of edema

Requires skill of application
Need frequent reapplication
Can slip and form a torniquet

What are the appropriate sizes

of bandages for amputees?
For above knee amputees two 6 inches
bandages sewn together and one 4 inch
bandage.
For below knee amputee two 4 inch elastic
bandage can be used.

What is the golden age of

prosthetic fitting?
It is the first 30 days following the
amputation.
Activities

Learn to put prosthesis

Weightshifting
Progressive ambulation between parallel bars
WalkeUneven terrain-stairs-ramps-curbs
Falling and getting-up

Transfer activities.
r-crutches-cane-unassisted on flat surfaces.

What are the different energy

expenditures for amputees?

Single BKA
Double BKA
Single AKA
Double AKA
Single AKA and BKA
Unilateral hemipelvectomy
with prosthesis
Crutch ambulation without
prosthesis
Wheelchair

9-28%
41-100%
40-65%
150%
75%
125%

50%
9%

What are the functional

classifications of amputees?

Class 1 Full Restoration

The individuals is functionally equivalent to normal
Class 2 Partial Restoration
The artificial limb is completely functional. The
person is able to work and engage in sports but on a
selective basis.
Class 3
Self-Care Plus
The individual is disabled and has physical limitation,
requires frequent adjustment of prosthesis.
Class 4
Self-Care Minus
Needs help from others because he is severely
disabled. Cannot go up and down the stairs without
assistance.

Class 5
Cosmetic Plus
The amputee is better off without a prosthesis
Class 6
Not feasible. Only a wheelchair is prescribed.

THE END

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