Amputation Z. Rozkydal •Amputation •Removal of periphery part of •the limb at a level of the bone •Disarticulation •Removal of periphery part of •the limb at a level of the joint • • p- pod kolenem 3 Amp 26 •Obr. 1. Amputation in the calf •Obr. 2. Disarticulation in the knee joint Indications •Severe ischemia •Severe trauma •Infection with sepsis •Malignant tumors •Congenital diseases •Neuropathies leading • to deep trophic ulcers Amp 15 •Obr. 3. deep necrosis in the calf •Preop. assessment •Individual access •Angiography •General condition •Occupation •Level of amputation- consultation •Technique •Turniquet •Safe surgical approach •Carefull ligating of vessels •Myoplastic surgery •- suture of muscles end to end •Dreinage of the wound •Enough soft tissues •Good skin coverage • - Amp 25 Amputace nohy •Amputation in the foot •Phalanx •Toes •A- Metatarsals- Sharp •B- Lisfranc •C- Bon-Jäger •D- Chopart •Level of amputation in the foot Amputace hlezna 2 •Amputation in the foot and in the ancle •Pirogov • • •Syme • • •Boyd • Amputace hlezna 2 Amputace hlezna 2 p- chopart •Amputation in Lisfranc joint p- chopart •Pirogov amputation •Amputation in the foot and the ancle p- chopart •Amputation in Chopart joint p- chopart •Syme amputation •Amputation in the foot and the ancle Amputace dle Boyda •Boyd amputation •Bellow knee amputation •8-15 cm bellow knee joint line p- p pod kolenem 1 •Bellow knee amputation Amputace v bérci 2 Ampurtace v bérci 1 •Above knee amputation p- nad kolenem •In the middle third of the thigh •Above knee amputation Amputace ve stehně 2 Amputace ve stehně 1 •Above knee amputation Amputace ve stehně 3 a- exartikulace v kyčli •Disarticulation of the hip •Hindquarter amputation •- hemipelvectomy a a- hemipel 2 •Amputation in the hand •Phalanx • •Fingers • •Metacarpals • • a- ruka •Disarticulation in wrist joint a a Amputace v předloktí •Amputation through forearm •Amputation through arm Amputace v paži •Above elbow amputation •Amputation in surgical neck • a- v chir •Disarticulation in the shoulder Amputace- v rameni a a •Forequarter amputation Amputace v rameni 2 •Interthoracoscapular amputation a •Osteoplastic amputation Ampurtace v bérci 1 •Gilotine amputation • •War surgery •One level cut of all structures •No suture of the wound •Requires reamputation •v •Elastic bandage to conical shape •Positioning •Prevention of flexion contracture •Proprioception •Exercise in bed •Verticalisation •Walking •Post op. management p- bandážování •The aim •Good quality stump • •Enough soft tissues • •Strong muscles • •Ability to walk • • p- amp nad kolenem 1 Amp 17 •Disarticulation in the knee region Amp 18 •Skin incision Amp 19 Amp 20 •Joint capsule incision, elevation of the patella Amp 21 Amp 22 •Dissection of posterior joint capsule, section of tibial nerve Amp 23 Amp 24 •Ligation of popliteal vessels, removal of the limb Amp 25 Amp 26 •Suture of the wound, healed stump •Suture withount tension Amp 29 •X - ray after disarticulation Amp 27 Amp 31 •Prosthesis after disarticulation of the knee region