Aboveknee amputations may be performed through the distal aspect of the femur supracondylar, the middle. A rationale for skew flaps in below knee amputation surgery. Despite biomechanical benefits and improved rehabilitation compared with above knee amputation aka, tka has largely been abandoned by vascular surgeons because of concerns for poor wound healing. Fixed knee contracture that would cause pressure on the distal stump after amputation aka is indicated in these cases.
Muscle compartments of the thigh muscle compartments of the leg saphenous nerve anatomy of the foot technique of hip disarticulation technique of above knee amputation technique of through knee amputation fasciocutaneous blood supply of amputations flaps of the leg technique of below knee amputation with long posterior flap technique of below knee amputation with skew flap. Increase muscle strength, so you can move more easily on your own. Above knee amputation 2 surgery video general surgery video. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. Compared with the changes that have taken place in the field of prosthetics, amputation techniques have changed little over the years. Indications for above knee amputation neoplasm the tumors most associated with above knee amputation are softtissue sarcoma and ewings tumor. Type of incision for below knee amputation, cochrane collaboration 2007. It may be above the knee, through the knee or below the knee.
Lower leg amputation surgery amputated leg duration. Pdf knee disarticulation versus aboveknee amputation. Full text get a printable copy pdf file of the complete article 1. Occasionally, if there are significant problems with healing or if extensive infection returns, you may need further surgery. Burgess technique versus modified bruckner procedure. No pillow should be kept under the knee in case of bk amputee. Doppler ischemic index transcutaneous oxygen pressure. The purpose of this study was to evaluate surgical outcomes of tka. Techniques long posterior myocutaneous flap modify skin flaps based upon available skin id neurovascular structures isolate fibula and transect 1. Woodburn mb chb, md frcsg gen, benjamin lindsey mb bs, frcse, in comprehensive vascular and endovascular surgery second edition, 2009. Emphasis is on flap design and meticulous dissection, use of continuous. Amputation can relieve signs and symptoms, improve function, and maintain or improve the patients quality of life.
This procedure may be necessary for a wide variety of reasons, such as trauma, infection, tumor, and vascular compromise. Posterior slab may be used in case of bk amputation, use stump board while sitting in wheelchair. Above elbow amputation same technique as the above knee amputation. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. The tendency of patient is to keep limb in flexion. Longterm followup study of bilateral abovetheknee amputees from the. Hip disarticulation is the surgical removal of the entire lower limb by transection through the hip joint. Above the knee amputations aka statpearls ncbi bookshelf. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. Full text is available as a scanned copy of the original print version. Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. The purpose of a transfemoral amputation is to obtain, by means of a myodesis, a dynamic stump with good motor control and sensitivity. The tourniquet is placed above the knee for amputations of the lower leg and foot, high in the thigh for amputations of the knee and lower thigh, and above the elbow to control the brachial artery for major amputations of the forearm.
Above the knee amputation discharge care what you need. Lower extremity amputations are most commonly performed because of advanced chronic peripheral arterial disease. Knee disarticulation case a 57yearold female with history of diabetes hamstring. Amputation is a blind and final method in surgery to save the patients life. 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. Below knee amputation same technique as the above knee amputation. This will also allow the prostheses to be less complex and more functional because the entire knee joint is not part of the prosthesis. Positioning and exercise program 2 dont put pillows between your thighs exercise 1. The main post surgical complications are cardiovascular, residual limb pain and phantom sensation, oedema. Most standard texts describe a conven tional transfemoral above the knee amputa from the department of orthopaedic surgery, univer. Above elbow and belowelbow amputations 301 figure 18.
You may need an amputation because of an injury, a tumor, or an infection. Above knee amputation or as posted at bedside by physiotherapist is very important. The patient needs to receive physiotherapy treatment early to avoid complications such as joint contractures, pathological scars and depressed psychological state. The sock should be pulled above your knee and all wrinkles should be smoothed out. Get a printable copy pdf file of the complete article 664k, or click on a page.
Exercises for strength and range of motion rehabilitation home program. In above knee amputation the skin is incised using a no. Cardiopulmonary disease and inability to tolerate surgery relative contraindications. Surgical proceduresamputation wikibooks, open books for. Surgical techniques in a transtibial amputation an osseous length of 1015 centimetres below the medial knee joint gap is optimal. In the absence of infection, the extremity is elevated to encourage venous drainage before a tourniquet is applied. According to the amputee coalition of america, almost one of every five people living with limb loss in this country has a transfemoral amputation.
However, the surgical technique of transfemoral amputation had remained unchanged until the late 1980s. Principles of amputation zollingers atlas of surgical. C aboveknee amputation for an osteosarcoma of the distal femur, performed in the early 1960s. A 20yearold female was a victim of blast injury to her right lower leg four hours prior to presentation at an emt. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Following these guidelines will help maximize your level of function. Alex performed an above the knee ak amputation on arizona. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free.
The patient should be independent with the exercise program and also understand. More aggressive vascular surgery, plastic reconstructive surgery i. The application of principles of plastic surgery in skin management must prevail. Surgical considerations in lower extremity amputation. The amputated limb is commonly known as the stump or residual limb. 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. The part of your leg that is not removed is called a residual limb.
A locking krakow suture technique is used within the tendon to obtain secure fixation and minimize devascularization of the tendon tissue. It is important to remember that the earlier the onset of rehabilitation, the greater the potential for success will be. The number of patients coming to above knee amputation after prosthetic replacement of the knee joint could be reduced by muscle flap cover of exposed arthroplasty prostheses. My sketch above showed the situation which we treated with two stage guillotine and final bka. Amputation is a surgical and reconstructive procedure that is a last resort. Problems with your leg veins or arteries, or complications of diabetes may also cause you to need an amputation. The indications for an above knee amputation include doubtful prospect of healing at the transtibial level, low likelihood of mobilization, and fixed flexion deformity at the knee. Amputation is the removal of a body extremity by trauma or surgery. Throughknee amputation is a feasible alternative to above. Pdf if belowknee amputation is impossible, knee disarticulation should be considered before aboveknee amputation, regardless of age and etiology. Medial hamstring tied up over femur after suturing the tendon with the anterior suture a, the medial hamstring is myodesed up and over the distal femur. The surgical technique is simple and nontraumatic since no bone or muscle tissue is.
At the final stage, standard technique involves creating the classic flap shown below. A reappraisal of a modified throughknee amputation in patients with. Above knee amputee usually develops flexion and abduction deformity. Get a printable copy pdf file of the complete article 573k, or click on a page image below to browse page by page. A bk amputation allows saving the knee and usually some part of the tibia bone that goes down to the foot. Secure bandage by wrapping around the distal thigh above the knee joint. Internationally, this type is also known as a transfemoral amputation because it occurs in the thigh, through the femoral bone. This is a tricky flap to make well because there are many variables the amount of muscle left, the thickness of the subcutaneous fat, the vascular supply, etc.
Amputation of the lower limb is a recognised procedure in the surgical management of. Techniques for lower extremity amputation uptodate. Even with a wellperformed amputation and a wellfitted prosthesis, some patients have persistent symptoms of residual extremity pain, swelling, and a sense of instability, as well as have a decreased length of prosthetic wear. Above the knee amputation is surgery to remove your leg above your knee cap. Above knee amputation technique tips and tricks from doctors. With the increased use of partial amputations, surgeons have developed many modifications of old stan. Trauma vascular insufficiency revision of lower site amputation due to nonhealing or illfitting limb prosthesis surgical details of procedure 1.
These should be removed and reapplied at least 4 times per day. Vascular surgery service, department of surgical education, greenville hospital system, 701 grove. Amputation of the leg either above or below the knee is the most common amputation surgery. Activities following a below knee amputation department of rehabilitative services 4153531756 this handout has been prepared as a guideline for activities and exercises for the first one to two months following your amputation. Skin incision and osteotomy site for belowelbow amputation. Therefore, using a standard tourniquet applied above the prepped field is not. The apex of the skin flap is marked on the lateral side of the thigh first. Hip extension pull your nonoperative leg up to your chest with your hands.
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