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Amputation of the lower limbs
Dpt. Of Orthopedic Surgery
Faculty of Medicine Masaryk University
Assistant Prof Dr Martin Prymek, Assistant Prof Dr Jan Kocanda
Amputation
-oldest historically documented operation (5,000 BC)
- ritualistic (sacrifices to the gods) -criminal effect (deterrent mutation)
- preventing the escape of a slave (preserving manual potential
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The greatest development in wars
- 1st World War = 100,000 amputations
- Historical reasons:
- limited technical possibilities of medicine
- insufficient medication options
- unavailability of anaesthesia
- ignorance of anti-shock therapy
- ignorance of asepse
- ignorance of blood transfusion
Prosthetics - Faculty of Medicine Masaryk University
Principles - Hippocrates - 500 BC - still valid
- Remove diseased tissue
- Reduce disability -Save a life
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Indikace k amputacím
- Trauma - reversible ischaemia
- Tumours - especially malignant
- Infect - long-term local processes
- acute sepsis from the lok. process
- Necrosis - including caused by physicists, effects - burns, frostbite, el. current - after demarcation of necrosis
- Function - or obstruction of proper functioning
- Soft tissue and skin cover defects
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Efforts to save the patient's limb must be realistically informed about:
- planned treatment procedure - the opposite. Performances -possibilities of developing both infective and sepsis
- possibilities of development of tissue necrosis
- expected duration of treatment
- socioeconomic aspects of treatment
-expected cosmetic and functional results of treatment
Worst situation - the limb is saved, but afunctional, painful and finally amputated after long hardships
Prosthetics - Faculty of Medicine Masaryk University
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Amputation
- Amputation
- Is the ediation of the peripheral part of the limb with a break in bone continuity
- Exarticulation
- Is the injury of the peripheral part of the limb at the site of the joint
Prosthetics - Faculty of Medicine Masaryk University
Indications
-Severe ischemia -Severe traumas
- Infection with sepsis
- Malignant tumors
- Congenital defects
- Neuropathy leading to trophotic ulcers
Prosthetics - Faculty of Medicine Masaryk University
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Before surgery
- Individual approach
-Condition of the limb- bloodshed (arteriography)
- General status -Job title
-Amputation height
- Consultation with a prosthetic technician
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Technique
- Usually anemic terrain
- Careful building of bleeding
- Accustomed operating procedures
- Quality skin cover of the amputation stump
- Muscle slicing distal and stitching together - myoplastic amputation of Ligature by arteries and veneer alone
- Bone prominence shedding
- Drainage of surgical wounds
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Amputation in the leg area
- Fingertips
- Fingers
- A - Metatarzy - Sharp
- B - Lisfrank -C - Bon-Jäger
- D - Chopart
Prosthetics - Faculty of Medicine Masaryk University
r^u- kg /Vmmi ^-/i /i«h hMtnrp 7; nhl/isti metatarsu (bodle Regenspurgera).
Prosthetics - Faculty of Medicine Masaryk University
Amputation in the leg and mucus area
Prosthetics - Faculty of Medicine Masaryk University
Amputation in the leg and mucus area
Amputation in Lisfrank's Amputation by Pirogov
joint
Prosthetics - Faculty of Medicine Masaryk University
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Amputation in the leg and mucus area
Amputation in Chopart's Amputation by Syme
joint
Prosthetics - Faculty of Medicine Masaryk University
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Amputation by Boyd
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Amputation in the loweH^
Prosthetics - Faculty of Medicine Masaryk University
Amputation in the thigh
Prosthetics - Faculty of Medicine Masaryk University
Amputation in the thigh
Prosthetics - Faculty of Medicine Masaryk University
Amputation in the thigh
Vostus medial!» muscle Femu
Sartorius muscle
Saphenous nerve Femoral artery ancfvein Adductor longus muscle
Adductor magnus muscle
Gracilis muscle
Semimem bronosus muscle
Rectus femoris muscle
Vastus intermedius muscle
Vastus
lateralis
muscle
Profunda femoris arfery and vein
Biceps femoris muscle (short head)
Sciatic nerve
Biceps femoris muscle (long head)
Semitendinosus muscle
Posterior femoral cutaneous nerve
Prosthetics - Faculty of Medicine Masaryk University
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Exarticulation in the hip
Tensor
fasciae lafae muscle
Gluteus medius muscle
Gluteus maximus muscle
Vastus lateralis muscle
Rectus femoris muscle
Sartorius muscle
Iliopsoas muscle
Femoral nerve, artery, and vein
Prosthetics - Faculty of Medicine Masaryk Univei&uy
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Pectineus muscle Short external rotator muscles
Adductor longus and brevis muscl
Prosthetics - Faculty of Medicine Masaryk University
Osteoplastic amputation
-Osteomyocutaneous lobe is added to the amputee stump
Prosthetics - Faculty of Medicine Masaryk University
Guillotine - circular amputation
-War surgery
- Intersetes all tissues in one plane
- Morning without sewing
- Requires reaputation - two-stroke amputation
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Myoplastic amputation
- Lobe cuts
-Stairline inters inters interses
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Exarticulation in the knee
Exarticulation in the knee
Tilting of the patella, discise of the joint housing
Prosthetics - Faculty of Medicine Masaryk University
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Exarticulation in the knee
Ceding of the posterior joint housing and n. tibialis
Prosthetics - Faculty of Medicine Masaryk University
Exarticulation in the knee
-Garter of popliteal
vessels - separation of the limb
Prosthetics - Faculty of Medicine Masaryk University
Exarticulation in the knee
- Sufficient soft
tissues -Suture wound
without tension
Prosthetics - Faculty of Medicine Masaryk University
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Postoperative care
- Shaping the stump with an elastic bandage
- Positioning
- Prevention of spot contracture
- Proprioception
- Exercises on the verticalization bed
Prosthetics - Faculty of Medicine Masaryk University
Goal
- High-quality tinge-type supporting stump
- Large surface
- Sufficient soft tissues -Strong musculature
- Muscle balance
Prosthetics - Faculty of Medicine Masaryk University
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Prosthetics - Faculty of Medicine Masaryk University
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Prosthetis
věnec
stěny
vrchol
Prosthetics - Faculty of Medicine Masaryk University
Prosthetics - Faculty of Medicine Masaryk University
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Interfax
• Hard socket with ply socks or nylon
• Themoplastic
• Gel Liner
• Soft inserts
(foam)
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Production of prosthesis
Prosthetics - Faculty of Medicine Masaryk University
Production of prosthesis
Prosthetics - Faculty of Medicine Masaryk University
Production of prostheses
Prosthetics - Faculty of Medicine Masaryk University
Prosthetics - Faculty of Medicine Masaryk University
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Prosthetics
Construction - module
Prosthetics - Faculty of Medicine Masaryk University
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Rehabilitation
-Stump stiffness
- Propriopce
- Fitness exercises -Coordination training -Walk
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Prosthetics - Faculty of Medicine Masaryk University
Zdroje
publikace LF MU, doc. Ivan Müller, CSc, doc. Z. Rozkydal, Internet
- BENDOVÁ, P., JEŘÁBKOVA, K., RŮJIČKOVÁ, V. Kompenzační pomůcky pro osoby se specifickými potřebami. Olomouc, 2006. ISBN 80-244-1436-8.
- JONÁŠKOVÁ, V. Protetické pomůcky osob s poruchou mobility. In Renotiérová M., Ludíková, L. a kol. Speciální pedagogika. Olomouc: UP, 2006. ISBN 80-244-1475-9.
- TŘASOŇOVÁ, Miroslava, LF MU 2005 PPT
- http://www.oajl.cz. http:// www.ms-protetik.cz. http:// www.erqon.czm .http:// www.altech-uh.cz. http:// www.ortoservis.cz. http:// www.zdravotniprodeina.cz
- http:// www.medicco.cz. http:// www.mevra.cz. http:// www.dmapraha.cz. http://www.petit-os.cz
- Janíček, P.: Ortopedie. Lékařská fakulta MU v Brně, 2001 Spoluautoři: Dufek, P., Chaloupka, R., Krbec, M.,Poul, J.,Procházka, P., Rozkydal, Z.
- Näder, E.M., Näder, H.G., Blomke, F: Otto- Bock Prothesen- Kompendium Prothesen fürdie untere Extermität. 2. Auflage, Schiele and Schön, 1993.
- Otto Bock: Technische Information, 2.3.5. ISNY - Island- Schweden, New York, 1990.
- Sosna, A., Vavřík, P., Krbec, M., Pokorný, D.: Základy ortopedie. Triton, 2001.
- Fotografie z LAOS (soukromá databáze Jan Kocanda)
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