AMPUTATION General

AMPUTATION General

Amputation should be considered when part of a limb is dead, deadly or a dead loss. A limb is dead when arterial occlusive disease is severe enough to cause infarction of macroscopic portions of tissue, i.e. gangrene. The occlusion may be in major vessels (atherosclerotic or embolic occlusions) or in small peripheral vessels (diabetes, Buerger’s disease, Raynaud’s disease, inadvertent intra-arterial injection). If the obstruction cannot be reversed and the symptoms are severe, amputation is required. Gabrielle Falloppio (Fallopius) , 1523–1563, Professor of Anatomy , Surgery and Botany , Padua, Italy . Friedrich Trendelenburg , 1844–1924, Professor of Surgery , successively at Rostock, Bonn and Leipzig, Germany . Leo Buerger , 1879–1943, Professor of Urologic Surgery , New Y ork Polyclinic Medical School, New Y ork, NY , USA, described thromboangiitis obliterans in 1908. Maurice Raynaud , 1834–1881, physician, Hôpital Lariboisière, Paris, France, described this condition in 1862. moist gangrene spreads to surrounding viable tissues. Cellulitis and severe toxaemia are the result. Amputation is required as a lifesa ving operation. Antibiotic cover should be broad and massive. Other life-threatening situations for which ampu - tation may be required include gas gangrene (as opposed to simple infection), neoplasm (such as osteogenic sarcoma) and arteriovenous fistula. Filaria A limb may be deemed a dead loss in the following circum - stances: first, when there is relentless severe rest pain without g angrene and reconstruction is not possible – amputation will improve quality of life; second, when a contracture or paralysis makes the limb impossible to use and renders it a hindrance; and third, when ther e is major unrecoverable traumatic damage. Summary box 61.3 Indications for amputation /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF /uni25CF

Dead limb Gangrene Deadly limb Wet gangrene Spreading cellulitis Arteriovenous /f_i stula Other (e.g. malignancy) ‘Dead loss’ limb Severe rest pain with unreconstructable critical leg ischaemia Paralysis Other (e.g. contracture, trauma)