If through a joint, you must nibble away the avascular cartilage
Especially for DM – use “tennis racquet” or V-shape incision anteriorly to be able to excise tendons proximal
Transmetatarsal = Digit + part of metatarsal
Ray amputation = Digit + metatarsal
Syme Amputation = Ankle disarticulation
Below knee
Above knee
Others (rare)
Lisfranc’s amputation = Through the tarsometatarsal joint
Chopart’s amputation = Partial foot amputation = Transtarsal amputation of the forefoot through the talonavicular-calcaneo-cuboid joint
Piroff’s amputation = Removal of the talus and rotation of the calcaneus
Knee-bearing amputation = Knee disarticulation
Through knee amputation useful if very FAST amputation is required or if there is femoral metal
Van-ness rotation / rotationoplasty = Foot being turned around and reattached to allow the ankle joint to be used as a knee
Hip disarticulation
Hemipelvectomy / hindquarter
Arm amputations: digits / metacarpal / wrist disarticulation / forearm (transradial) / elbow disarticulation / above-elbow (transhumeral) / shoulder disarticulation / forequarter amputation / Krukenberg procedure (converts a forearm stump into a pincer by separating the radius & ulna to provide a pincer like grasp powered by pronator teres)
Hemicorporectomy
Level of Amputation Determined by:
Blood supply
In general, presence of a palpable pulse in major artery immediately above the amputation site (e.g. popliteal for BKA) indicates a high probability of amputation primary healing
Rehab potential / Pt overall condition
Prosthesis:
BKA: 25-40% extra energy expenditure
AKA: 60-100%
NB: Digit/ray amputations should be carried out through shafts of bones as the joint cartilage will secrete fluid into the wound and slow healing
Tendons are avascular and should be divided as proximally as possible
Management
Use compressive garment / Stump shrinker – to control oedema
Massage techniques – to soften scar and ↓ sensitivity
Orthotics – for diabetics & anyone with anything more than a digit amputation
Prognosis
45% suitable for prosthesis
15-50% of diabetic amputees will lose a second leg within 2-5 yrs (M > F)
20% of pts undergoing major amputation (BKA or AKA) will be dead within 2yrs
50% 5YS (cf 85% for age-matched controls); less in diabetic pts