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Amputations are caused by:
3) Congenital Disorders
What is Amputation ?
Almost all leg amputations are performed because you are suffering from the effects of blood vessel disease. This means that you have either hardening of the arteries, poor artery circulation or a large clot in the artery which cannot be removed. Less common reasons include cancer, severe injury or infection, and congenital deformities. The most likely cause for amputation in patients with severe artery disease is the presence of severe pain or the possible development of gangrene. Amputation, however, is always a last resort and will only be recommended if it does not look possible to improve the circulation in any other way. Arm amputations are much less common and are usually needed because of extensive injury.
Figure : (A) Angiosarcomatosis of the leg and foot. Note the multiple lytic lesions of the distal third of the tibia, fibula, and talus.
(B) Sagittal cut of the surgical specimen. The entire tibial medulla is occupied by the tumor. Note the anterior cortical breakthrough and soft-tissue extension.
Below the knee amputation is surgery to remove all or part of your foot or your leg below the knee cap. It is also called BKA. You may need a BKA for a health problem that causes poor blood flow, such as diabetes. You may have a severe infection or a blood clot. You may have been in an accident that injured your leg beyond repair. You may also need a BKA if you have cancer, or were born with a deformed leg. Amputations are either planned or done in an emergency. Caregivers will only remove as much of your foot or leg as is absolutely necessary. After a BKA, you may be fitted for a prosthesis (artificial leg) for your residual (remaining) limb.
You and your caregiver will work together to decide if other treatments should be included in your treatment plan. You may need hyperbaric oxygen treatment to help heal infections. You may need surgery to provide new blood vessels to your leg if you have blood flow problems. If you have cancer, you may need surgery to remove the tumor and graft a donor bone in its place.
Below the Knee Amputation Procedure
In a below the knee amputation procedure, a skew or posterior flap may be used, depending on the amount of skin damage. The leg is removed some 12-15 cm below the knee joint. There are major healthcare risks involved for the older patient, with 20% experiencing major complications. However, younger patients tend to fare better on average. Patients requiring below the knee amputation are advised to stop smoking and refrain from drinking. Healthcare advice also involves background checks on allergies, medications, and other variables that might adversely affect the outcome.
Types of lower limb amputation include :
The foot will be amputated through the ankle joint leaving the tibia and fibula in tact. This can be limiting to the amputee for the types of prosthetic devices due to the lack of room from the end of the residual limb to floor.
A transtibial amputation (sometimes one sees transtibal amputation) is an amputation above the foot but below the knee. Transtibial amputees have the greatest hope of regaining normal mobility. The knee is the part of the leg involving the most complex biomechanics; as this is intact for all transtibial amputees, the process of mimicking native leg movement becomes much easier for this population.
A transfemoral prosthesis is an artificial limb that replaces a leg missing above the knee. Transfemoral amputees can have a very difficult time regaining normal movement. In general, a transfemoral amputee must use approximately 80% more energy to walk than a person with two whole legs.This is due to the complexities in movement associated with the knee.
A knee disarticulation is an amputee that requires a prosthesis that usually weight bears from the remaining condyles of the femur. The knee cap, tibia and fubula have been removed.
is an operative procedure where a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.
The operation is also called a Van-ness rotation.
A hip disarticulation in most cases has a complete pelvis and will be missing the femur and below amputated.
A hemipelvectomy is a high level pelvic amputation. Along with hip-disarticulations, hemipelvectomies are the rarest of lower extremity amputations. In some cases, an internal hemipelvectomy can be performed, which is a limb-sparing procedure. A complete hemipelvectomy, however, is the amputation of half of the pelvis and the leg on that side.
This type of procedure is also called transpelvic amputation.
You will have a general anaesthetic and be asleep or sometimes just an injection to numb you below the waist. If the latter takes place, you will be awake, you might feel that ’something is happening’ in your leg but you will not feel any pain from the waist down. A cut is made so that, after removing the diseased part, you end up with a rounded stump made of healthy skin. You should plan to be in the hospital for a month to cover any delay in healing of the wound. You may well be out before this. You may need alterations to your home, such as bath handles, and ramps, which will help you when you return. You will need to have a temporary wheelchair and learn how to use it
There are significant risks attached to undergoing an amputation, especially if you are elderly and have diabetes and/or narrowing or hardening of the arteries due to vascular disease (atherosclerosis/arteriosclerosis).
In this group of patients, the chances of dying in hospital after a major amputation (below or above knee) are somewhere between 10 - 20 percent.
In other words, between 1 in 10 and 1 in 5 patients who undergo a major amputation due to atherosclerosis, sometimes in combination with diabetes, will die in hospital.
This is why amputation is always a last resort and a surgeon advises a patient to undergo this operation only when it is absolutely necessary.
These statistics also mean that 4 out of 5 patients undergoing an amputation will do well.Up to 85 percent of all lower limb amputations among diabetics are preceded by a foot ulcer.
The extra concentrations of glucose in their blood have a damaging effect on the blood vessels and nerves, leading to a loss of circulation and sensation in feet.
This damage can put diabetic feet at increased risk of infection and ulcers, which if left untreated can lead to serious complications, such as gangrene and sepsis (blood poisoning).
Disturbingly, research shows that diabetics who have had one lower limb amputated have a 50 percent mortality rate in the five years following the amputation.
As well, they have 50 percent risk of developing a serious lesion in the second limb within two years, often leaving them immobile and putting them at risk of further complications from their diabetes.
There are always risks with surgery. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. Sometimes bleeding may cause a collection of blood called a hematoma. This may need to be drained to prevent infection. It may be difficult for your wound to heal. Your caregivers will watch you closely for these problems. Some people continue to feel the part of their leg that has been amputated. These are called phantom feelings. These feelings are normal and may or may not be painful.
If you do not have surgery, your problem could get worse. If you have cancer or a badly infected leg and do not get treatment, with time you could die. Call your caregiver if you are worried or have questions about your medicine or care.
Other complications of amputation surgery include:
- Chest infection
- Heart attack
- Pressure sores
- Wound infections in the stump
- Failure of the stump to heal
- Knee or hip joint contracture
- Deep venous thrombosis in the leg
- Phantom limb pain
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