Indications for amputation

Soft tissue can be severed in various ways. Depending on the technique used, the shape of the scar is determined.

Rehabilitation after amputation

Amputation of a leg is a life-changing experience. However, it is possible to survive them with minimal losses. To this end, comprehensive rehabilitation should be carried out to enable a return to life and, if possible, to work as quickly as possible.

• Early phase – post-operative care, therapeutic exercises, etc;
• preparation for prosthetics;
• prostheses;
• Learning to walk with a prosthesis – carried out in a walking school;
• Social adaptation of the person with a prosthesis in their usual environment;
• Vocational rehabilitation – if the amputation affects the person's current activity, a new activity must be learned.

During this period, medical supervision is required and examinations are carried out as necessary.

Professional psychological help and support – individual or group therapy – is also very important.

Basic rehabilitation

Immediately after a leg amputation, care must be taken to ensure that the wound heals well. This requires regular treatment of the wound with antiseptics and the use of healing ointments. Painkillers should also be taken to relieve the pain.

The wound heals on average 3 to 4 weeks, after which a scar begins to form. It is important to keep the skin of the scar clean and moisturized, e.g. B. by applying a cream. It is also advisable to massage the scar gently to avoid adhesion.

• Wash with baby soap;
• Gradually increase the firmness of the towel to make the skin less sensitive;
• Massage with a brush as it adjusts.

Early rehabilitation after a leg amputation serves to prepare for prosthetics. It is carried out under the guidance of doctors. The goal is to properly shape the stump, eliminate pain and avoid complications. The goal is to properly shape the stump, eliminate pain, and avoid complications such as joint contractures, pressure sores, and phantom limb pain.

• therapeutic exercises;
• Massage – lymphatic drainage and general massage, as well as self-massage, which the doctor teaches the patient;
• Edema therapy – bandaging, silicone compression cuffs, compression stockings, residual limb elevation;
• Breathing exercises.

Surgical amputation

Surgical amputations are an indication for diseases of other organs and systems. Especially gangrene. There are two types of gangrene: dry gangrene and wet gangrene. The actual mechanism is blockage of blood circulation, accompanied by tissue necrosis. For this condition, amputation of the leg may be the only option.

The causative agent of gangrene is an infection with Clostridium difficile. Clostridia produce toxins that prevent healthy cells from functioning. Gangrene often affects the distal peripheral parts, including the toes. In this clinical picture, amputation of the big toe or another necrotic part of the foot is indicated.

Indications for surgical amputation of the lower limbs include the following conditions:

• gangrene due to diabetes;
• Atherosclerotic gangrene;
• Buerger's disease;
• Acute ischemia due to thrombosis and embolism.

More than 60 % of amputations are due to diabetic gangrene. Vascular degeneration and clinical manifestations of critical ischemia have an acute course in the lower limbs. In practice, amputation of the leg above the knee - the thigh - is often necessary.

While in the early stages of sclerotic artery damage the limb can be preserved, in the more advanced stages of foot ganglion lesions surgical treatment is performed.

Young men who enjoy sports are susceptible to Buerger syndrome. In this case, vascular surgery cannot fundamentally change the situation. To avoid amputation of the leg above the knee, a tissue graft may be used. If this fails, a maximum of one third of the lower extremity can be amputated.

Thrombosis and embolism lead to gangrene within days or hours. With ischemic gangrene, leg amputations are performed to prevent general disability. Leg amputation for gangrene is therefore a necessary measure.

Rehabilitation after amputation

The leg after an amputation requires intensive therapy and preparation for fitting with a prosthesis. Therapy should include measures to heal the stump, pain relief and psychological support. The doctors of the specialist clinic help to eliminate the disability after a leg amputation. The clinic offers comprehensive care and Rehabilitation of amputee patients.

The consequences of not performing an operation.

Metabolic disorders often occur due to blockages in the subcutaneous arteries and capillaries in the arm. This leads to a lack of nutrients and oxygen in the tissues. Cell death begins. The first symptoms are not alarming - pale skin and loss of sensitivity, occasional coldness in the arm. A rapidly growing ulcer then develops. Therefore, to prevent the infection from spreading, the following should be considered Amputation.. Attempts to avoid amputation of the hand in favor of gentle treatment lead to a generalization of the bacterial infection in the internal organs. If necrosis has developed in the finger, only the dead finger is removed. Hand resection is performed when necrosis involves all fingers or the metacarpal region.

hand amputation.

Amputation of the hand can lead to loss of ability to work. The physiotherapists at the specialist clinic (Osterhofen) focus on the challenge and necessity of restoring comprehensive motor function to the limb.

One-stage reconstruction of the hand after amputation is not possible, but our physiotherapists will find the right exercises and simulators to help you regain your ability to work.

An individual exercise and rehabilitation program will be designed for you, and doctors will monitor your progress and give you advice. You will soon feel and see that your hand function has been restored. You should not rule out the possibility of returning to your previous job.

Stages of amputation

The amputation of fingers, hands and feet at the level of the knee or above requires several steps:

1. Preparation for surgery. The patient will undergo a comprehensive physical examination to minimize the risk of complications during or after surgery. Preoperative psychological preparation is also important. It has already been proven that if the patient takes this step consciously, cooperates with the psychologist and adapts accordingly, recovery from the procedure and all subsequent rehabilitation will be successful. For this reason, psychologists work in many large clinics.
2. Administering anesthesia to the patient. Modern medicine is increasingly relying on spinal anesthesia. These medications block nerve endings in the spine area. The patient can remain conscious but does not feel anything. Sedation is also used to reduce stress – the patient is put into a medically induced sleep state.
3. Incision, separation of soft tissues. At this stage, doctors work with the soft tissues – skin and muscle fibers. Flaps are applied to create a rudimentary limb.
4. Working with blood vessels and nerve endings. The correct handling of vessels and nerves is very important, which is why vascular surgeons and neurosurgeons are often involved in the operation. The nerve endings are compressed in a special way. On the one hand, it is important to ensure the sensitivity of the stump in order to simplify the rehabilitation process. However, it is equally important to spare the patient pain during the healing phase.
5. Bone dissection. After preparing the soft tissue and using special sterile equipment, the bone is resected.
6. Shaping the stump.
7. sew up.

Covering the stump after surgery.

Disabled groups

A disabled person who has survived the amputation of a limb due to injury or illness is entitled to a pension. There are three groups:

• Group one – total disability, inability to care for oneself;
• Group two – partial disability;
• Group three – partial disability with the ability to live a full life.

If a person is missing a finger, they are placed in a third disability group. If a person loses a hand or foot, they can be placed in disability group two, but can move to disability group three after successfully fitting a prosthesis. In the first disability group, the limb is removed and the joints are removed without inserting a prosthesis.

Minor amputations in the Innovative Vascular Center

In our clinic, amputations are only performed in cases of complete necrosis in combination with critical ischemia. To make a clear indication for amputation, we always perform an x-ray and a detailed blood flow assessment. In cases of critical ischemia, we only perform major finger amputations after complete restoration of blood flow and isolation of the necrotic process.

The operation is carried out as an emergency procedure. In preparation, clinical blood and urine tests and an electrocardiogram should be performed. In order to predict wound healing, the blood supply to the foot tissue must be assessed.

How is the operation performed?

• The patient is placed on his back. The surgical field is properly treated and isolated with sterile towels.
• In the case of gangrene, amputation must be carried out in two stages. First, the dead tissue is removed within the healthy tissue, and after a few days a stump forms if there is no infection.
• The toe can be removed by cutting the metatarsal bone or metatarsal bone, in which case the procedure is called an amputation, or the toe can be removed from the joint by evisceration.
• After the procedure, the doctor always assesses the bleeding from the wound; if it is weak, the level of excision should be higher. A pathological-anatomical examination of the amputated limb is necessary to determine the cause and type of lesion.

Because amputation of a finger or hand is a minor procedure, the risk to life is low. The most important complications after surgery occur when the indication for surgery is incorrect. If the amputation is carried out at the level of tissue with poor blood supply, the wound will never heal after such an amputation but will abscess and continue to spread. In this case, the operation must be repeated on healthier tissue. In the case of the hand, the goal of a finger amputation should be to preserve as much length and function as possible without going beyond the metacarpal, as the hand is the most important working instrument in a person's life.

Suturing the stump too early, especially in diabetic gangrene (in patients with diabetes mellitus), can lead to rapid spread of the pus process and sepsis. Therefore, a two-stage procedure was used in our clinic.

If the blood supply is marginal or the surgical technique is poor, a long-term, non-healing residual wound to the limb or terminal osteitis can occur. In this case, multiple operations are required to remove the inflamed tissue.

Preparation

Before the operation, the patient undergoes several diagnostic tests: – Clinical examination of blood and urine, biochemical analysis of blood – Ultrasound examination of the arteries and veins of the upper limbs – X-ray examination of the lungs and bones of the upper limbs. – Electrocardiogram The patient must be examined by a vascular surgeon, a reconstructive plastic surgeon and a cardiologist. The patient signs a voluntary consent form for the procedure.

Anesthesia for amputation: general anesthesia, regional anesthesia or local infiltration anesthesia. The patient lies on his back with his arm upright on the table next to the operating table. The hand is treated with an antiseptic solution and the surgical field is covered with sterile towels.

Stages of amputation

Medical students are often asked: What are the basic principles of upper limb amputation? These principles are different from those of lower limb amputation. While leg amputation focuses on preserving function and walking, arm amputation is about maximizing the functionality of the upper limbs. The best results are achieved with minimal amputation and maximum mobility of the limb.

Bones and soft tissues must be treated carefully, and the amputation level and method must be chosen correctly. Traumatic amputation requires careful handling of the bone fillet to avoid re-amputation and osteitis due to possible infection. By following these simple rules, trophic ulcers and anaerobic infections can be avoided in primary amputations.

In the case of finger gangrene, it is important to preserve the first (thumb) and little finger (fifth finger) or leave them for longer, as they are involved in an important gripping function.

Although it is important to maintain the length of the stump, the forearm has a thin layer of fascial skin, which can pose a problem in covering bone chips and subsequently lead to wound formation. Therefore, the amputation is performed at the border between the lower and middle thirds of the forearm. Two lobes are excised. The vessels in the wound are ligated and the nerves are supplied. The bones are sawn off and the bone chips are treated. The wound is drained and sutured.

The Kruckenburg amputation is performed as an additional surgical procedure for amputations at the level of the forearm. It is used for double arm amputations or for blind patients. This is the name given to a functional stump in the shape of a 'pincer' that allows the patient to carry out gripping movements at the elbow joint (elbow joint disarticulation).

Amputation of the arm at shoulder level occurs 4 cm above the elbow joint, which allows the creation of a functional prosthesis with flexion, extension and rotation mechanisms. The stump is shaped with two skin-tissue flaps, a long one from the anterior surface of the arm and a short one from the posterior surface. The stump wound is drained.

Stages of arm amputation

The operation is usually performed due to trauma or a circulatory disorder. The vessels that narrow toward the fingers may not receive adequate blood flow, leading to necrosis.

finger

When removing the finger, doctors try to save as many joints as possible. This is because even a single phalanx of a finger still functions well if the problem is recognized early.

Since the bone is too short in this case, the excision is performed at the nearest joint. The wound is closed with a cloth.

hand

This can be partially or completely removed. This is one of the problem areas for prostheses. This is why silicone implants are often used.

forearm

Includes dissection of the radial and ulnar regions. A sleeve and tube are used as a prosthesis to mimic the forearm. Expensive handles can supplement the lost function. And they can be covered with silicone to mimic skin.

poor

Removal requires an incision in the area between the elbow and upper arm. The humerus is filed away and flaps of skin form the stump.

The prosthesis in this type of surgery consists of several modules: a cuff, an elbow motor, a forearm simulator and an electronic handle. A cosmetic silicone treatment gives the prosthesis a natural look.

Postoperative complications

Amputation is a serious procedure. It must be performed by a qualified surgeon. Improper treatment can lead to the following consequences:

• Penetration of infection into the wound;
• necrosis of healthy tissue;
• Heart problems;
• brain damage;
• Embolism;
• Lung infection;
• gastrointestinal diseases;

Therefore, all phases – preparation, implementation, aftercare – must be taken seriously.

Indications and contraindications

There are a number of indications for excision of body parts. If these are present, the doctor can carry out the procedure.

1. Optional. Removal of irreversibly damaged fingers due to trauma, malignant tumor, ischemia or infection is performed.
2. Replacement surgery. A borderline amputation is carried out.

A limb amputation is only carried out if there is a strict indication. Doctors are interested in preserving the patient's fingers.

Preparing for surgery

Before amputation, the patient must be adequately prepared. The doctor will refer the patient for examinations. Blood and urine tests as well as angiography are necessary. X-rays may also be ordered.

If there are infectious processes, preoperative antibiotic therapy is carried out before amputation of the finger. A diabetes check is carried out. Doctors assess the blood supply to the tissues of the limb to provide a prognosis for wound healing.

rehabilitation

Rehabilitation has specific goals. The stump should be prepared for prosthetic treatment and the prosthesis should be adapted to the individual needs of the patient. It is also important that the user learns how to use the prosthesis, how to go back to work and how to actively participate in social life.

It is also important that the patient works with a psychologist. It is not uncommon for trauma to lead to withdrawal from the body, loss of meaning in life, and complexes. Interacting with a psychologist will allow you to regain your self-confidence and motivation. You can discover new opportunities and then return to an active and fulfilling life.

It is not uncommon for patients to undergo physical therapy, which can help normalize blood circulation. Muscle tension can be restored and pain and swelling can be eliminated.

Rehabilitation usually lasts more than a month because it takes a long time to fully recover.

Benefits of Surgery at Miracle Doctor Clinic

Miracle Doctor Clinic has been operating for more than 23 years. The specialists deal with the diagnosis and treatment of diseases in more than 40 areas. The services offered comply with all national and international standards.

1. The doctors approach each patient individually.
2. The specialists are ready to provide assistance in emergencies in the operating room or trauma department.
3. The doctors carry out the diagnosis competently, so that errors are excluded.
4. Modern equipment is used to perform amputations.

You can make an appointment on the Miracle Doctor website by selecting a referral, date and time. Alternatively, you can call and ask the consultant to make an appointment with a specific doctor.

indications

Operations are performed for vital indications. Amputations and disarticulations are performed due to lacerations, extensive trauma with bone crushing, vascular injuries, soft tissue defects or contusions, as well as in cases where existing surgical techniques do not allow restoring the integrity of the limb. A significant proportion of procedures are carried out after vascular diseases (obliterative arteritis, atherosclerosis). In addition, amputations and disarticulations of the lower limbs are performed for extensive infections (for example, phlegmon), malignant tumors (osteogenic sarcoma), deep burns and frostbite with extensive or deep necrosis.

Depending on the degree of limb removal, operations in this group are divided into disarticulations and amputations of the femur, tibia, foot and toes. There are different types of amputations and disarticulations, depending on the circumstances of the procedure and the cause of the limb separation:

• Primary. Amputations are performed for the first time and are due to the non-viability of the lower limbs as a result of disease or trauma.
• Secondary. These include limb amputations performed due to medical errors or complications (e.g., spread of infection, necrosis due to treatment of atherosclerosis or diabetic foot syndrome).
• Recurrent amputations. This group includes amputations performed for the second, third and subsequent times. Indications may include a malformed stump, insufficiently radical primary amputation, etc.

Stages of amputation

In traumatology, various procedures are used to close a stump. The double flap technique, in which an anterior and a posterior skin flap is created, is the most commonly used for all approaches to the stump. One flap is shorter and the other is longer, so that the surgical scar is not on the end of the stump, but on the anterior or posterior surface. Amputation includes the following steps:

• Formation of the skin flap, separation of the muscles.
• Dissection and debridement of the periosteum, sawing of the bone, edging of the end surface.
• Tying off the large vessels and cutting the nerves.
• Stitching the wound.

If the amputation is carried out for emergency reasons (infection, trauma, necrosis), the soft tissues are checked for viability during the procedure. Nonviable soft tissue is excised. Disarticulation involves the same steps as amputation, but instead of cutting the periosteum, sawing the bone, and manipulating bone fragments, the joint is opened and the distal bone is extracted. The stitches are usually removed on day 10-12 after surgery. Once the wound has healed, physical therapy is recommended and the patient is given a prosthesis.

• The reamputation is.
• blunt.
• Limb amputation.
• The toe formation.
• Life after a leg amputation.
• acetabulum.
• What to do with amputated limbs?.
• prosthetic legs.