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Amputation principles

Indications for Amputation:

  1. Peripheral vascular disease

  2. Trauma

    1. Insensate limb distally

    2. Facilities

    3. MESS score

  3. Infection

  4. Tumours

  5. Nerve injury (trophic ulceration)

  6. Congenital anomalies

Aims:

  • Return Patient to maximum level of independent function

  • Ablation of diseased tissue

  • Reduce morbidity & mortality

  • Considered first part of a Reconstruction to produce a physiological end organ

  • Requires a Multidisciplinary approach

Pre-operative Evaluation

  1. Tissue
    1. Clinical - feel pulses, skin temperature, level of dependent rubor
    2. Doppler - Ankle/ Brachial index more than .45 = 90% healing; inaccurate with calcified vessels
    3. Toe systolic BP - 55 mm Hg min for distal healing
    4. Transcutaneous PO2 min 35 for assured healing
    5. Arteriogram
    6. Other:
      1. Skin blood flow (Xe 133 clearance)
      2. thermography
      3. thallium scanning
  2. Immune Competence
    1. serum albumin at least 3g/dl
    2. WCC more than 1500/ mL
  3. Systemic
    1. control diabetes
    2. evaluate cardiac, renal + cerebral circulation
    3. Preop TPN in malnourished pt
  4. Psychological
    1. early plan for return to function
    2. preop counselling
    3. amputee support groups
  5. Preop Pain Control
    1. Pain clinic review
    2. Spinal anaesthesia


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