Amputation - a surgical operation aimed at removing limbs or parts of it, which prevents normal function of the healthy limb, and in addition, causes pain and nekupiruemuyu or risk of infection. Amputation is used as a last resort in treatment.
The indications for amputation may be severe injury or tumor, but more often the cause of amputations are due to peripheral arterial disease atherosclerosis. When atherosclerosis is disturbed blood flow in the tissues due to narrowing of the lumen of blood vessels. this causes the tissue cells that do not get enough oxygen and nutrients. Most of all this deficit manifests itself in the most remote areas of the heart - the fingers and toes. Necrosis begins with these body parts. In this case initially appears pale, cold fingers. Next comes a little sore, which is growing rapidly, and black. Necrosis of tissue. Acceding infection worsens the condition of the tissues. As a result, the question arises about the amputation, as changes in the tissues become irreversible and the delay in surgery is fraught with serious complications. A little history of amputation surgery
Amputation - one of the oldest operations. Hippocrates held amputation within the dead tissue, and later offered to hold her Celsus grabbing healthy tissue, which was more appropriate, but in the Middle Ages it was all forgotten. In the XVI century Paré suggested that ligation of vessels instead of cauterization with a hot iron or lowering the boiling oil, after Louis Petit was to cover the stump skin, and in the XIX century offered Pirogov osteoplastic operations.
The most common operation performed amputation of limbs with vascular diseases, tumors and severe trauma.
Vascular diseases of the extremities - the leading cause of amputations in people aged 50 years or older, and occupies 90% of all amputations. Usually the treatment of complicated disease is antibiotics, removal of infected tissue, the appointment of vascular drugs (eg anticoagulants), and surgery is in operations such as angioplasty, bypass surgery, stenting. However, when these measures can not help to achieve the desired result, the surgeon has to resort to amputation as a life-saving measures.
In addition, vascular injury may occur in severe (crushed, split) injuries, deep burns. As a result, as there is a lack of blood tissue necrosis and limb. If you do not remove the necrotic tissue, it is fraught with the spread throughout the body products of putrefaction and infection.
Amputation is used in the treatment and malignant tumors, such as osteogenic sarcoma, etc.
What are the main points of amputation surgery?
Cut out of skin - aponeurotic flap
The muscles are cut with a knife
Processing of the periosteum
Sawing the bone
Treatment of bone sawdust.
Treatment of nerve: the tip is cut off below the ligature with a razor blade
Revision of the stump, excision of nonviable muscle (not reduced, the color of cooked meat).
Separate ligation of arteries and veins
The seam on the muscles (except for severe ischemia, gunshot wounds, anaerobic infection)
All amputations, for whatever reason, they are not enforced, is produced in four stages:
Dissection of the skin and soft tissue
cutting bone
wound treatment, ligation of vessels, nerves truncation
suturing of wounds
After the amputation
Depending on the situation after the amputation, the patient is from 5 to 14 days. Sutures are removed on the 7-8th day after surgery. Antibiotics, analgesics and drugs aimed at treatment of atherosclerosis. After some time, appointed physiotherapy. Usually after amputation raises the question of prosthesis. Approximate dates of prosthetics are within 10 - 14 days, but ultimately it depends on the situation.
Complications after amputation
Usually after the amputation of limbs occur in the remote so-called phantom pain. This means that the patient begins to feel its remote end, it starts to hurt, there is a desire to scratch it.
Skin necrosis in the area of the stump. This occurs under the condition of poor blood supply to the tissues of the stump. Keloid scars. This perversely-wide gross scarring. The emergence of envy for the most part not on the quality of the operating surgeon, but from the disposition. Angiotrofonevroz - this condition occurs when damage to the nerves during amputation. It is noted pain in the scar.
