What Is a Transfemoral Amputation?

Trans-thigh 1/3 and mid-low 1/3 amputations are suitable for malignant tumors of the calf or knee joint, severe congenital calf or knee deformities, and loss of function.

Mid thigh and lower middle 1/3 amputations

Right!

Trans-thigh 1/3 and mid-low 1/3 amputations are suitable for malignant tumors of the calf or knee joint, severe congenital calf or knee deformities, and loss of function.

Mid thigh and lower middle 1/3 amputations

Pediatric Surgery / Amputation and Arthrotomy

84.17

Amputation and joint dissection is a destructive operation that has long been regarded as the main method of surgical treatment of malignant bone tumors, saving patients' lives at the expense of limbs. In recent years, with the widespread application of effective chemotherapeutic drugs and the advancement of surgical techniques, especially the preservation of extensive local excision of limbs, attempts to treat malignant bone tumors have obtained satisfactory results, which has significantly reduced the adaptive certification of amputation surgery. According to the new concept of local tumor resection, the role of amputation and joint dissection in the treatment of malignant bone tumors should be re-understood. Due to the choice of the amputation plane, the amputation or joint dissection may be a radical tumor resection, a general tumor resection, or a marginal tumor resection. Therefore, amputation or joint dissection does not always achieve a radical resection of malignant bone tumors. Nevertheless, amputation and joint dissection are still one of the main methods to achieve radical resection of malignant bone tumors. When limbs cannot be retained, amputation or joint dissection should be performed decisively.

The indications for amputation and joint dissection are:

1. Primary highly malignant bone tumors with no long-distance metastasis, that is, those with surgical stage IIB and some IIA.

2. Primary highly malignant bone tumors with metastases elsewhere, surgical stage , such as metastatic tumors can be surgically removed; or in order to reduce pain and eliminate the local infection of the lesions, amputation or joint dissection Broken surgery.

3. For primary malignant bone tumors, although the surgical staging is B and A, they have lost the conditions for local extensive excision of the retained limbs.

Selection of amputation or joint dissection plane: According to the extent of tumor invasion of bone and soft tissue and the need to install prosthetics, determine the amputation or joint dissection plane. Amputation of the tumor at the proximal end of the tumor 5-7cm can achieve extensive local resection of the tumor. Because articular cartilage, bone growth plate, and joint capsule are barriers to the direct spread of tumors, the proximal joint dissection of bone malignant tumors can be used to achieve radical tumor resection, and the bone growth plates of proximal tubular bones are retained to make stumps. Grow at normal speed. Although, with the development of prosthetic technology, the requirements of stump length for the installation of prosthetic limbs have been relaxed, that is, the impact of stump length on the installation of prostheses has been significantly reduced, and a well-healed stump is more important. However, in principle, as long as the radical resection of the tumor can be achieved, the length of the stump of the limb is preserved as much as possible.

1. Biopsy must be performed before amputation to obtain a positive pathological diagnosis.

2. Routine whole body radionuclide bone scan and chest radiograph, except for distant metastases of the tumor.

3. Select CT scan, MRI and angiography to determine the affected area of bone and soft tissue, and determine the amputation or joint dissection plane.

4. Poor body conditions, anemia and malnutrition, should be corrected before surgery.

5. Decide whether to perform chemotherapy before surgery according to the determined chemotherapy regimen.

6. For those who have decided to amputate or sever the joint, they must obtain the consent and signature of their parents, and then report it to the higher medical administrative department for approval before performing the operation.

Epidural or general anesthesia. The patient takes a supine position.

1. The stump of the limb is wrapped with a sterile gauze pad and bandaged with an elastic band.

2. Raise the foot on one end to raise the stump, avoid the stump of the stump and prevent hip flexion and contracture.

3. Closely observe the stump bleeding, remove the drainage strip 48h after surgery.

4. Actively perform rehabilitation training after amputation and prepare for prosthetic assembly.

1. Mid thigh and lower middle 1/3 amputations 1. Bleeding and hematoma formation

Major hemorrhage due to large blood vessel ligation is not rare, but you should be highly vigilant. A rubber tourniquet was prepared by the bedside after the operation. Closely observe the bleeding of the dressing. Once a major hemorrhage is found, a tourniquet should be tied immediately and an emergency surgery should be performed to stop the bleeding.

2. Transmedullary thigh and lower middle 1/3 amputations 2. Joint contracture

Lower limb amputations can cause joint contractures, especially when the sitting time is too long or the stump of the residual limb is too high and too long, which can cause hip flexion and abduction contractures, which will affect the assembly of the prosthesis. Therefore, postoperative plaster fixation should be used to keep the hip joint in the extended position, and patients should be encouraged to perform contraction exercises and joint function training of hip extension and knee extension.

3. Mid thigh and lower middle 1/3 amputations 3. Phantom limb pain

Patients often feel that the amputated limb is still present after surgery, and they have acupuncture and numbness. This phantom limb sensation can gradually fade away without affecting the wearing of prosthetics. However, a small number of phantom limb pains are manifested as unbearable pain of the entire phantom limbs, which persist, especially at night, and the pathogenesis is unclear. Therefore, there is no effective treatment method, and acupuncture, physical therapy and mental therapy can be adopted. Procaine closure or sympathectomy is also feasible.

4. Mid thigh and lower middle 1/3 amputations 4. Neuroma and stump pain

Nerve stump has nerve fiber regeneration to form neuroma, which is an inevitable pathological phenomenon. But only about 10% of patients develop painful neuromas. It may be related to the compression of the neuroma by the end of the bone, the surrounding scar tissue wrapping and scar adhesion. For those who do not respond to non-surgical treatment, surgically remove the neuroma and place the stump into the normal muscle space.