Amputation Z. Rozkydal Amputation Removal of periphery part of the limb at a level of the bone Disarticulation Removal of periphery part of the limb at a level of the joint p- pod kolenem 3 Amp 26 Obr. 1. Amputation in the calf Obr. 2. Disarticulation in the knee joint Indications •Severe ischemia •Severe trauma •Infection with sepsis •Malignant tumors •Congenital diseases •Neuropathies leading • to deep trophic ulcers Amp 15 Obr. 3. deep necrosis in the calf Preop. assessment Individual access Angiography General condition Occupation Level of amputation- consultation Technique Turniquet Safe surgical approach Carefull ligating of vessels Myoplastic surgery - suture of muscles end to end Dreinage of the wound Enough soft tissues Good skin coverage - Amp 25 Amputace nohy Amputation in the foot Phalanx Toes A- Metatarsals- Sharp B- Lisfranc C- Bon-Jäger D- Chopart Level of amputation in the foot Amputace hlezna 2 Amputation in the foot and in the ancle Pirogov Syme Boyd Amputace hlezna 2 Amputace hlezna 2 p- chopart Amputation in Lisfranc joint p- chopart Pirogov amputation Amputation in the foot and the ancle p- chopart Amputation in Chopart joint p- chopart Syme amputation Amputation in the foot and the ancle Amputace dle Boyda Boyd amputation Bellow knee amputation 8-15 cm bellow knee joint line p- p pod kolenem 1 Bellow knee amputation Amputace v bérci 2 Ampurtace v bérci 1 Above knee amputation p- nad kolenem In the middle third of the thigh Above knee amputation Amputace ve stehně 2 Amputace ve stehně 1 Above knee amputation Amputace ve stehně 3 a- exartikulace v kyčli Disarticulation of the hip Hindquarter amputation - hemipelvectomy a a- hemipel 2 Amputation in the hand Phalanx Fingers Metacarpals a- ruka Disarticulation in wrist joint a a Amputace v předloktí Amputation through forearm Amputation through arm Amputace v paži Above elbow amputation Amputation in surgical neck a- v chir Disarticulation in the shoulder Amputace- v rameni a a Forequarter amputation Amputace v rameni 2 Interthoracoscapular amputation a Osteoplastic amputation Ampurtace v bérci 1 Gilotine amputation War surgery One level cut of all structures No suture of the wound Requires reamputation Elastic bandage to conical shape Positioning Prevention of flexion contracture Proprioception Exercise in bed Verticalisation Walking Post op. management p- bandážování The aim Good quality stump Enough soft tissues Strong muscles Ability to walk p- amp nad kolenem 1 Amp 17 Disarticulation in the knee region Amp 18 Skin incision Amp 19 Amp 20 Joint capsule incision, elevation of the patella Amp 21 Amp 22 Dissection of posterior joint capsule, section of tibial nerve Amp 23 Amp 24 Ligation of popliteal vessels, removal of the limb Amp 25 Amp 26 Suture of the wound, healed stump Suture withount tension Amp 29 X - ray after disarticulation Amp 27 Amp 31 Prosthesis after disarticulation of the knee region