Conversion rates increased with a more proximal occlusion on dus. Amputations above and below the knee are common surgical procedures performed by vascular, orthopedic, and general surgeons. Throughknee amputation tka is a rare amputation performed in aug 18, 2011. This creates a situation similar to many knee disarticulation patients. Blood vessel disorders such as atherosclerosis, often secondary to diabetes mellitus, account for the greatest percentage of amputations of the lower limb. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free. Aboveknee amputation and hip disarticulation thoracic key. The surgical technique is simple and nontraumatic since no bone or muscle tissue is to be dissected. Pain after amputation bja education oxford academic. The operation of the below knee amputation is sadly not an infrequent operation in the foot and ankle surgical world.
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. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. Knee arthrodesis versus abovetheknee amputation after. The transfemoral amputation level, part 1 amputee coalition. The transfemoral amputation level, part 2 amputee coalition. After the amputation 6 transfemoral above knee manual a recommended approach everyone reacts to an amputation differently. Surgical revision for stump problems after traumatic above. How i do below knee amputation linkedin slideshare. General principles of amputation surgery uw orthopaedics. Amputation is at the hip joint with the entire leg removed.
This article will focus on surgery and postoperative management. Above the knee amputation discharge care what you need. The indications for these procedures include infection, acute ischemia, chronic progressive ischemia, trauma, intractable pain, neuropathy, and. Amputation is the most ancient of all surgical procedures. Throughknee amputation is a feasible alternative to above. Below knee amputation surgical technique orthoracle. Comfort silver liner stump sheath, antiodor, antimicrobial, 2 sheaths. Amputation occurs at any level between the knee and the ankle. The preferred incision during a knee disarticulation extends from the attachment of the ligamentum. Amputation is a surgical and reconstructive procedure that is a last resort. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications.
Aboveknee amputations may be performed through the distal aspect of the femur supracondylar, the middle section of the femur diaphyseal, or just below the lesser trochanter high aboveknee. We have analyzed the association of multiple clinical factors with the morbidity of 1028 consecutive amputations performed in 786 patients during a year period. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. Duplex ultrasound may predict the best level of lower limb. Below knee amputation an overview sciencedirect topics. Above knee amputation below knee amputation midfoot amputation.
Unlike individuals with a knee disarticulation, a person with a transfemoral amputation can no longer take the bodys weight directly on the transected end of the limb. If the above considerations rule out a transtibial amputation, a knee disarticulation may be considered. Below knee amputation 2 surgery video general surgery video. Learn the below knee amputation surgical technique with step by step instructions on orthoracle. Aboveknee amputation technique download here free healthcaremagic app to ask a doctor all the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Total hip replacement in an ipsilateral abovetheknee. Many patients have only marginal blood supply and the utmost surgical care and technique is required to maximize their wound healing potential. Our elearning platform contains high resolution images and a certified cme of the below knee amputation surgical procedure. Amputation occurs at any level between the hip and knee joints. One surgical technique to use for knee disarticulation amputation is with equal sagittal flaps after kjolbye starting anteriorly above the tibial tubercle and. The apex of the skin flap is marked on the lateral side of. An abovetheknee amputation aka is the surgical removal of the leg above the knee.
Transfemoral aboveknee amputation or aka, transtibial belowknee. An amputation is performed as far above the affected area as is necessary to remove all unhealthy tissue and to leave a. 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. Increase muscle strength, so you can move more easily on your own. Amputations can be either planned or emergency procedures. The thigh muscles are completely preserved and thus there. For abovekneeamputations aka flexion and abduction. Surgical amputation is currently performed in cases of bone and tissue cancers, gangrene, and uncontrollable infections of the arm or leg. The transfemoral amputation level, part 2 surgery and. In manual of surgical pathology second edition, 2006. The lower leg will also be shorter than the opposite leg.
This resulted in a belowknee amputation instead of an aboveknee amputation that was originally planned. Amputation is one of the oldest surgical procedures with artificial limbs. Higher aboveknee amputations are generally used for primar y bone sarcomas of the distal femur. A bk amputation allows saving the knee and usually some part of the tibia bone that goes down to the foot. Woodburn mb chb, md frcsg gen, benjamin lindsey mb bs, frcse, in comprehensive vascular and endovascular surgery second edition, 2009. Thirtynine reoperations were performed, of which 17 stump revisions and 22 conversions were from below to above knee amputation. Aboveknee and belowknee amputation basicmedical key. Low aboveknee amputations are used for bone sarcomas of the leg, especially those involving the popliteal fossa or arterial trifurcation. Amputation of a hand or foot was a common punishment in many of the older socalled civilized societies and is still carried out today in. When viewed in this light, the amputation becomes a surgical challenge instead of a. Amputation is the removal of a body extremity by trauma or surgery. Amputation is a blind and final method in surgery to save the patients life.
The clinical and surgical considerations surrounding aboveknee amputations, as well as details of the surgical technique, are described in this chapter. The technique, results, and fol lowup are described. Patients who underwent above knee aka or below knee amputation bka from 2005 to 2010 were identified from the american college of surgeons national surgical quality improvement program acs. Fathi aboveknee amputations may be performed through the distal femur supracondylar the midfemur diaphyseal, or just below the lesser trochanter high aboveknee amputation tumors of the distal femur high aboveknee amputation tumors of the leg standard aboveknee amputation surgical technique the patient is supine, and the operated extremity should be. The indications for an aboveknee amputation include doubtful prospect of healing at the transtibial level, low likelihood of mobilization, and fixed flexion deformity at the knee. Higher above knee amputations are generally used for primar y bone sarcomas of the distal femur. Just as plastic surgical techniques are required in operating on the hand and foot, the same techniques of gentleness in skin and other tissue handling are applicable to amputation surgery. It is performed to remove diseased tissue or relieve pain or due to trauma. Low above knee amputations are used for bone sarcomas of the leg, especially those involving the popliteal fossa or arterial trifurcation. Types of lower extremity amputation and considerations. Get a printable copy pdf file of the complete article 664k, or click on a page image below to browse page by page. Comfort regal prosthetic socks, comfortable and durable, fleeced interior. Get a printable copy pdf file of the complete article 573k, or click on a page image below to browse page by page. The conventional, constant friction knee joint used in most above.
Injury and arterial embolisms are the main reasons for emergency amputations. The most common indication for amputation of an upper limb is severe trauma. Amputations through the knee joint or just above the knee joint grittistokes amputation can also sometimes be performed. The patient should be independent with the exercise program and also understand. The indications for an aboveknee amputation include doubtful prospect of healing.
As with all surgery, careful judgement is necessary in the selection of suture and closure technique, and the amputation surgeon must be aware of the options and differences between various techniques. This will also allow the prostheses to be less complex and more functional because the entire knee joint is not part of the prosthesis. Surgical proceduresamputation wikibooks, open books for. Amputation is the intentional surgical removal of a limb or body part. It plays a small part in hip movement, but chiefly is involved in knee movement. In those times, surgical amputation was a crude procedure by which a limb was rapidly severed from an unanesthetized patient. The term for the surgical technique to reattach muscles to. Although various techniques to determine amputation level have become available, obvious clinical factors may yet identify patients in whom a major amputation is unlikely to heal. Reasons for an aka include poor blood flow which cannot be corrected resulting in tissue loss or extreme pain, severe infection, trauma or injury, tumor or congenital disorder.