Surgical amputation is an intervention usually implemented to manage vascular complications or control an ongoing pathological process, such as a malignant tumor. This treatment can also be indicated for preventive purposes to limit the consequences of these same problems.
, vessels, nerves, bone and muscle).Less correctly, the term is used in common medical practice, to refer to the "removal of other parts of the body (for example:" breast amputation "to refer to mastectomy to treat breast cancer).
The end of the amputated limb is called the amputation stump.
, irreparable trauma or a severe pathological process in the affected limb. Most of these interventions are performed to manage peripheral vascular complications, mainly related to diabetes, arteriosclerosis and gangrene of arterial origin (eg. Bürger's disease ).
Amputation can also be used to prevent particular problems, such as, for example, to prevent the extension of a particularly aggressive malignant tumor or to limit damage in the presence of necrotizing processes.
Surgical amputation is an operation performed since ancient times; over time, the techniques used to remove the part of the limb affected by the pathology have undergone an evolution in a conservative sense, that is, there is a tendency to limit, as far as possible, the extent of the amputation.
Spontaneous amputation
Spontaneous amputation occurs mainly in the limbs affected by gangrene (in common language also called gangrene). In this situation, it is possible to observe that the healthy part clearly delimits the diseased one, until the latter detaches spontaneously.
Gangrene is a type of tissue necrosis generally caused by a lack of blood supply in the affected part. This condition can result from severe traumatic injuries, frostbite, infections and other situations in which the necrotic process (ie tissue death) is irreversible.
For further information: Cancrena - What it is, Causes and SymptomsTraumatic amputation
"Physical trauma amputation is a" occurrence that is observed mainly in the case of road accidents (cars, motorcycles, bicycles, etc.) and accidents at work (chainsaws, presses, equipment for processing meat or for cutting wood, etc.). ). A limb or a segment of it can be severed in the event of an impact, explosion and stab wound.
This event can also occur due to the sudden breaking of a rope (metal or rope), the interlocking between the gears of a machine or the effects of firearms.
In traumatic amputation, the loss of the limb can be the direct consequence of the event, ie it occurs immediately during the accident (for example: a finger accidentally cut by the blade of a table saw. Sometimes, the amputation occurs a few days later, due to medical complications.
In most cases, the fingers of the hand are involved. The traumatic amputation of a limb, partial or total, creates the immediate danger of death from the copious loss of blood.
Congenital amputation
Congenital amputation is a rather rare occurrence that occurs when the unborn child is still in the uterus.
This particular shape almost always results from the presence of a bridle of the amniotic membrane, which acts as a constricting band directly on a limb of the fetus, causing its amputation.
Other forms of amputation
- In some countries, including Saudi Arabia, Yemen, the United Arab Emirates and Iran, amputation of hands or feet was used (or even continues to be used) as a form of legal punishment for people who have committed crimes.
- Amputation can be found for war causes, such as war wounds and acts of terrorism. Less often, however, self-amputations are observed performed for fraudulent purposes (for example, to receive insurance money) or as a form of protest.
- Self-amputations can be the consequence of Body Integrity Identity Disorder (BIID), a rare and severe psychiatric disorder. People suffering from this condition experience an intense desire to amputate one or more parts of their body.
- Certain cultural or religious traditions provide for the practice of minor amputations as an initiation ritual to emphasize the transition from one condition to another (for example, from childhood to adulthood). Some African tribes and Australian Aborigines, for example, practice the avulsion of the incisors as a ritual ceremony. Scarifications, facial disfigurations (rhinotomy, ear amputations, and so on), circumcision or mutilation (infibulation and clitoridectomy) can also assume the meaning of belonging to a community.
- Infections resulting from the diabetic foot;
- Circulation problems;
- Focal deficit of the proximal part of the femur;
- Fibular hemimelia;
- Supernumerary fingers (eg polydactyly);
- Atherosclerosis;
- Buerger's disease (or Bürger's disease);
- Freezing.
Usually, partial amputations are preferred to preserve the joint. In cancer surgery, however, disarticulation (ie amputations performed at the level of a joint) is preferred.
In general, the technique varies according to the extent of the disease: the different levels of surgical amputation and the respective skin incision lines try to provide the prosthesis with a valid and functional residual stump.
Some examples of surgical amputation
LOWER LIMBS
- Toe amputation
- Partial amputation of the foot (note: the most common techniques are those of Chopart and Lisfranc);
- Disarticulation of the ankle (eg amputation of Syme, a. Of Pyrogoff etc.);
- Trans-tibial amputation (commonly referred to as a "below the knee amputation);
- Patella amputation (knee disarticulation)
- Trans-femoral (above the knee) amputation;
- Disarticulation of the hip (amputation of the lower limb at the hip joint).
A particular example of major amputation related to the leg is hemipelvectomy, ie the surgical removal of half of the pelvis and of the ipsilateral lower limb. This type of intervention is practiced above all in the case of malignant tumors or bone metastases extended to the hip and to the sacrum.
Another example of a very invasive intervention is the amputation combined with the Van-Ness rotation, in which the foot is rotated 180 ° and thus sutured to allow the use of the ankle joint as if it were a knee and ensure greater effectiveness of the prosthesis.
UPPER LIMBS
- Amputation of the fingers of the hand;
- Metacarpal amputation;
- Wrist disarticulation
- Trans-radial amputation (commonly referred to as forearm or below elbow amputation);
- Elbow disarticulation
- Transhumeral amputation (above the elbow)
- Shoulder disarticulation.
A variant of the trans-radial amputation worth mentioning is the Krukenberg technique, which offers the restitution of a certain "manual", using the ulna and radius bones to create a stump similar to a pincer.
.Next, the muscles are dissected and the bone is severed with an oscillating saw.
The flaps of skin and muscle fibers are placed over the stump, occasionally with the insertion of elements to facilitate the application of a prosthesis.
Muscles should be attached under conditions similar to normal physiological conditions. This allows for effective muscle contraction, capable of:
- Reduce the atrophy of the part;
- Allow functional use of the abutment;
- Maintain soft tissue coverage of residual bone.
The technique of distal stabilization of the muscles for which the most preferred is myodesis (direct suture of the muscle to the bone or to the periosteum). In joint amputations of disarticulation, however, tenodesis can be used, where the tendon is attached to the bone .
The artificial prosthesis is applied a few months after the operation; the patient is supported with a rehabilitation program.
How is the level of amputation determined?
Compatibly with the aims of the intervention, the amplitude of the amputation is established in such a way as to allow:
- An "adequate arterial spraying of the residual part;
- The application of the orthopedic prosthesis.
As far as possible:
- The surgeon who practices the amputation tries to preserve the limb;
- The blood supply must be sufficient at the level of the amputation, to avoid complications and further interventions;
- The point where to perform the amputation must allow the patient to use the artificial limb effectively.
Characteristics of the Amputation Abutment
The "ideal" abutment should:
- Have good muscle trophism;
- Maintain efficient blood circulation;
- Don't be sore.
The part that remains from the amputation is usually reconstructed with stabilization and microsurgery techniques to favor the continuity of the limb.
Post-operative management
After the amputation, in the post-operative regime, it is important to:
- Facilitate wound healing, reduce edema and prevent the risk of infection;
- Maintain the strength of the limbs and the extension of the joints, preventing contractures and limitations to mobility;
- Desensitize the stump (as anticipated, it must not be painful).
In the past, amputation involved a profound disability; thanks to the continuous and remarkable evolution of surgical techniques (in terms of haemostasis, asepsis, anesthesia and microsurgical practices) and to the development of orthopedic prostheses, it is currently possible to recover with excellent results and resume their daily activities, however limited by the impairment.
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