What Are the Different Reasons for Limb Amputation?

Forearm amputation is a primary malignant tumor of the limb, severe infection of the limb, severe and extensive damage to the limb, insufficient blood supply to the limb due to arterial thrombosis, thromboocclusive vasculitis, arteriosclerosis, diabetes, etc. There has been a kind of surgical operation such as obvious necrosis. The following will explain in detail the indications of forearm amputation, preoperative preparation, anesthesia, surgical procedures, intraoperative precautions and postoperative treatment.

Forearm amputation

Forearm amputation is a primary malignant tumor of the limb, severe infection of the limb, severe and extensive damage to the limb, insufficient blood supply to the limb due to arterial thrombosis, thromboocclusive vasculitis, arteriosclerosis, diabetes, etc. There has been a kind of surgical operation such as obvious necrosis. The following will explain in detail the indications of forearm amputation, preoperative preparation, anesthesia, surgical procedures, intraoperative precautions and postoperative treatment.

Chinese name

Forearm amputation

Indication 1

5. Congenital multi-finger (toe) can be truncated.

Indication 2

Severe and extensive injury to the limb

Indication 3

Primary malignant tumor of the limb

1. The primary malignant tumor of the limb should be amputated at an early stage. Early in the course of the disease, the lesions are limited to the bone, and those without long-distance metastasis may consider resection of the tumor and replantation of the distal limb.

2. Severe infection of the limb (such as uncontrollable gas gangrene), or severe sepsis complicated by purulent infection that cannot be controlled by drugs and general surgery, which threatens the patient's life. Those who do not amputate are not enough to save their lives. They should be amputated in time.

3. If the limb is severely and extensively damaged and cannot be repaired or replanted, amputation should be performed immediately.

4. due to arterial thrombosis, thrombo-occlusive vasculitis, arteriosclerosis, diabetes, etc. due to insufficient blood supply to the limbs, who have obvious necrosis, should be amputated.

5. Congenital multi-finger (toe) can be truncated.

6. The severe deformity of the limb affects the function, but the orthopaedic operation can not improve the function. If the amputation can be improved after the amputation, the amputation can be considered.

1. Amputation will bring severe mental and physical trauma to the patient. Therefore, the necessity of amputation and the problems in the assembly and use of prostheses should be explained to the patient and his relatives in detail, and the ideological work should be done well. If it is an open amputation, it must be stated that the amputation must be performed again.

2. Patients who amputate after open amputation, it is best to wait for the wound to heal after surgery; if it does not heal, skin graft should be performed first.

3. Except for those with necrosis of limb due to insufficient blood supply, all amputations should be provided with an inflatable tourniquet at the proximal end of the amputation plane to reduce blood loss and keep the surgical field clear.

4. In general, those with poor conditions and high amputees should be prepared for blood transfusion before surgery to prevent shock.

5. Various special circumstances, such as diabetes, malignant tumors, etc., should be controlled with insulin or anti-tumor drugs before and after surgery.

Brachial plexus anesthesia is used for amputations far from the elbow joint plane; general anesthesia is used near the elbow plane; spinal or epidural anesthesia is used for lower limbs; general anesthesia is applied to children, adolescents and nervous adults.

1. Posture supine position, the trunk of the affected side is as close as possible to the edge of the operating table, the diseased limb is abducted, and placed flat on another small operating table. An inflatable tourniquet is placed on the upper arm.

2. Design the amputations above the wrist joint of the flap. The anterior and posterior flaps should be equal in length, each equal to 1/2 of the diameter of the truncated plane (about 1/3 circumference). The intersection of the anterior and posterior flaps is in the osteotomy plane. The lateral midpoint is such that the incision scar falls exactly in the middle of the stump. Mark the skin tangent and cut plane on the body surface. Cut the skin, subcutaneous tissue, and deep fascia, separate under the fascia, and turn the flap up to the cut plane.

3. Cut off blood vessels, nerve separation ulnar, radial artery, median nerve, ulnar nerve, and cut off after routine treatment. Note that the anatomical position of blood vessels and nerves will be different in different cut planes. For the blood vessel and nerve positions of different sections, see the cross-section of the limb and see the replantation of the limb (finger).

4. Amputate 2 cm below the amputation plane, use amputation IX to be perpendicular to the bone, cut off the muscles in a circle, cut the periosteum at the level of muscle retraction, protect the proximal muscles, cut the ulnar and radial bones, amputate the limb, and file the plane edge .

5. Dispose of the stump to loosen the tourniquet to stop bleeding completely. After the proximal pressure is applied to check the ligation of the blood vessel, the section can be washed, the length of the muscle and flap can be trimmed, the deep fascia and the flap can be sutured after the rubber drainage, and the stump is finally bandaged under pressure.

1. The ideal cut-off plane of the forearm is the junction of the middle and lower 1/3. For amputations below the 1/3 of the forearm, the blood supply to the skin flap will be insufficient, and the stump is prone to coldness and bruising, and it is not suitable to assemble artificial limbs.

2. Interosseous blood vessels are not easy to be exposed and ligated in advance. Therefore, after excision of the limb to loosen the tourniquet, interosseous blood vessels should be treated to reduce blood loss.

3. If it is found that the radius and ulna are close to each other during surgery, especially in children with amputations, the thin bone flap should be used to cover the bone end to prevent cross healing and affect the forearm rotation function.

1. Muscle spasm and joint flexion caused by pain in the amputated limb, suture tear or joint contracture can occur. The splint should be fixed in the functional position after operation, and the triangle towel can be used to hang on the neck. When it doesn't hurt, early functional exercise should be encouraged.

2. Prepare a tourniquet before the bed. Close observation after surgery, if there is major bleeding, you should immediately stop the bleeding with a tourniquet; then surgical exploration.

3. Pay attention to the occurrence of local infection. Local pain and fever all over the body should be checked and treated accordingly. If there is no secretion from the wound, remove the cigarette for drainage 1 to 2 days after the operation.

4. Generally, the suture is removed 10 to 14 days after the operation.