Amputation technique

introduction

With the amputation technique, a distinction must be made between whether the amputation wound is closed immediately or not until a second operation.
One speaks of a closed or an open operation. The open, so-called two-stage amputation, became particularly important in cases of war and catastrophes and can be associated with considerable disadvantages such as soft tissue and muscle retraction and drying of the bones.
Due to various drainage and vacuum techniques, however, there is rarely the need to leave a stump completely open.

method

The most important principle in amputation is to preserve the extremity as much as possible, since the longer the lever arm, the better the patient's control over himself prosthesis Has.
Unfortunately, this general rule is restricted in certain situations. First of all, the Amputation level to be determined. In general, the amputation is performed through tissue that will heal satisfactorily and at a level at which any pathologically altered parts will be removed.

Insufficient blood flow

In case of a lack of blood flow When determining the height, the blood flow in the skin flap is a more important criterion than the condition of the large vessels.
If joints are to be preserved and thus better mobility achieved, the tissue blood flow must be precisely determined.
In the area of ​​the leg or lower leg, the question is usually whether that is Knee joint can be obtained or not.

tumor

In the treatment of extensive bone tumors, the tumor be much wider in the bone than it is on the X-ray image or the Scintigraphy was seen and has to be amputated more than initially assumed.

Stump restoration

In addition to maintaining as much length as possible, it is also important to ensure that the residual limb can be covered with sufficiently normally sensitive and scar-free skin. This is because insensitive or transplanted skin can only tolerate the pressure of a prosthesis poorly and is very likely to fail. This problem mainly affects the lower extremity, as it is heavily stressed. But it is also a problem in the case of traumatic injuries with burns and abrasions. An exception are children in whom a stump with an active growth plate (epiphyseal plate) is covered with skin should, because in this case the skin grafts are less sensitive.

It is also important that the stump is using Musculature is padded. If the surgeon has difficulty sewing the opposing muscle groups over the bone without tension, the surgeon must shorten the bone to make the suture easier.
Large vessels located in the muscle must be tied off individually when the muscles are divided, while smaller ones can be scabbed off by heat.

Neuromas

In order to avoid the formation or the consequences of benign but painful nodules in the nerves (neuromas), which can happen when a nerve is cut, the nerve must be cut as close to the body as possible, otherwise one Compression of the neuroma the prosthesis can lead to severe pain.

Bone occlusion

On the one hand, the bone cavity (marrow cavity) is closed on the bone sutured periosteum strips (Periosteal strips), but also an extension and stabilization of the bone Periosteum or Bone chips performed. One of the goals is e.g. on the lower leg Shin and Fibula to protect against compression by the prosthesis through a stable bone connection.

General information about the operation

While of the surgery the patient usually has to take general anesthetic be treated. A tourniquet is necessary for reasons of clarity and to avoid major blood loss in the case of major amputations. The blood is kept away from the operated area with the help of a tight cuff that is attached above the amputation area. However, if the cuff is in place for too long, tissue loss can occur.

To Termination of surgery become one or more Drainage hoses introduced into the operating area to remove the wound fluid Muscles and intercept the bone surface. After a few days, the drain can be removed again. The wound can be adequately treated with the help of a pressure bandage.

If there is a risk of infection, as can be the case after trauma or vascular disease, prophylactic measures should be taken antibiotic given during or before surgery.