Skip to main content

AMPUTATION

ABOVE KNEE AMPUTATION “Mangled Extremity Severity Score (MESS)” 

Indications:

  • Unsalvageable limb due to non-reconstructable peripheral vascular disease or extensive trauma.
  • Life-saving where ischaemic leg is causing sepsis but patient is not fit for major revascularization.
  • Failed below knee amputation where the stump has broken down. 

Procedure:

  • Position the patient supine under spinal anesthesia
  • Skin antisepsis by betadine scrubbing and draping 
  • Marks the planned incision line by fish-mouth shaped flaps with anterior and posterior flaps.
  • Apply thigh tourniquet 
  • Incision along the marked line and hemostasis with electrocautery
  • Identifies, ligate with vicryl and dissects the femoral artery and vein
  • Identifies and dissects the sciatic and saphenous nerves. 
  • Transect the bone using an oscillating or Gigli saw
  • Protect the soft tissues
  • Irrigate wounds thoroughly with normal saline and hydrogen peroxide
  • Verify and hemostasis  
  • Place drains beneath the fascial layer
  • Close fascia with vicryl 1.0 and subcutaneous with 2-0 vicryl
  • Skin closure with 2-0 nylon 
  • Place a compressive dressing

BELOW KNEE AMPUTATION

Indications:

  • Chronic or acute ischaemia of limb that fails to respond to surgical revascularization. 
  • Gross tissue necrosis resulting in septicaemia. 
  • Extensive foot sepsis, especially in diabetes when debridement alone will result in loss of weight-bearing surface. 

Procedure: Operative steps (Burgess long posterior flap):

  • Measure the circumference of the leg a hands breadth below the tibial tuberosity. 
  • The length of the anterior incision should be two-thirds the length of the circumference at this level. 
  • The length of the posterior flap should be one-third of this circumferential length.
  • Divide the fibula 2cm proximal to the tibial division.
  • Divide the tibia 12cm below the tibial tuberosity. 
  • The tibia should be bevelled at an angle of about 45° halfway through the bone. 
  • After this the bone should be divided transversely to make the end of the stump more rounded.
  • The division of the bone should be at least 1cm above the skin incision.
  • Ligate the posterior tibial and peroneal vessels and nerves.
  • Fashion a myocutaneous flap and bring it forward to stitch it to the anterior tibial fascia using Vicryl
  • Close the skin with interrupted Ethilon® or skin clips.

Post operation treatment: 

  1. PIV NSS 0.9% 1000ml/24H
  2. Ceftriaxone (1g): 1fl x 2 (IVL)
  3. Gentamycin (80mg): 1A x 2 (IM) (FOR 5 Days)
  4. Metronidazole (500mg): 1fl x 2 (PIV)
  5. Paracetamol (1g): 1fl x 3 (PIV)
  6. Tramadol (100mg): 1A x 2 (IM)
  7. Cimetidine (200mg): 1A x 2 (IVL)

Comments

Post a Comment