SURGICAL NURSING
BY:
SR. FATMATA JOHNSON
&
MR. MOSES MOHAMED TARAWALLY
AMPUTATION
INTRODUCTION
• Amputation is the most ancient of surgical procedures. Historically,
were stimulated by the aftermath of war. It was a crude procedure -
limb was rapidly severed from anaesthetized patient. The open stump
was then crushed or dipped in boiling oil to obtain hemostasis.
Hippocrates was the first to use ligature.
• As a surgical measure, it is used to control pain or a disease process in
the affected limb, such as malignancy or gangrene. In some cases, it is
carried out on individuals as a preventative surgery for such problems.
DEFINITION
Derived from the Latin word “AMPUTARE” meaning ‘cutting around’
It is the traumatic or intentional surgical removal of any body part or limb
It could also be the removal of the diseased, non-functioning, protruding
body part
Purpose: To remove diseased tissue or relieve pain.
• Hemicorporectomy (trans lumbar amputation or "halfectomy") is a
radical surgery in which the body caudal to the waist is amputated,
transecting the lumbar spine
• Disarticulation – where a part is removed through a joint
INCIDENCE
• Age;- common between 50-75 yrs of age
traumatic - common in the young age
• Sex;- approx.. 75% male
25% female
• Limb;- approx.. 85% - lower limb
15% -- upper limb
CAUSES OF AMPUTATION
1. Injury/Trauma:- RTA, Gun shuts/blast wounds, crushed injuries,
occupational hazards etc.
2. Poor circulation (Peripheral Vascular Disease):- Arteriosclerosis,
Thromboembolism, Diabetes, DVT, Prior stroke etc.
3. Infection:- Cellulitis, Osteomyelitis, Fulminant Gas Gangrene,
Sepsis, Infected trophic ulcer, Necrotizing fasciitis etc.
4. Nerve injury:- Diabetic peripheral neuropathy, Neuroma
(growth/tumor of nerve tissue
5. Congenital anomalies:- Extra digits, Incomplete formation of a limb,
deformities etc.
6. Malignancies (Cancer):- Tumors, Osteosarcoma etc.
7. Others:- Burns, Frostbite, legal punishment, snake bite etc.
TYPES OF AMPUTATION
There are basically two (2) types of amputation, these include:
1. Open amputation: It is done due to presence of infection. Cross
section of skin is left open for drainage and skin traction is applied to
prevent retraction. (secondary closure)
2. Closed amputation: An Amputation in which one or two broad flaps
of muscular and cutaneous tissue are retained to form the cover over the
end of the bone. It is done when there is no infection present. (primary
closure)
LEVELS OF AMPUTATIONS
Levels of Amputation depends on the following factors:
Extend of disease
Healing potential of stump
Rehabilitation of the patience
Levels of Amputation is divided on the basis of body region:
1) Upper limb Amputation
2) Lower limb Amputation
UPPER LIMB AMPUTATION
• Trans-phalangeal or Finger Amputation: Amputation of the finger
or a portion of the finger
• Trans-carpal or Partial hand Amputation: removal of a portion of
the carpals
• Wrist Disarticulation: amputation through the radiocarpal joint
• Trans-radial or below elbow(BE) Amputation: amputation through
the radial and ulnar bones (forearm bones)
• Elbow Disarticulation: removal of the elbow joint
• Trans-humeral or above elbow(AE): amputation above the elbow
through the arm (humerus bone)
• Shoulder Disarticulation: removal of the shoulder joint
• Inter-scapulothoracic (forequarter) amputation: Removal of the
entire shoulder girdle
LOWER LIMB AMPUTATIONS
• Hemipelvectomy (Hind quarter amputation): Removal of Leg, Hip
and Pelvis
• Hip disarticulation: amputation through the hip joint
• Trans-femoral or Above Knee(AK) Amputation: amputation
through the femur
• Knee Disarticulation: amputation through the knee joint
• Trans-tibial or Below Knee(BK) Amputation: amputation through
the tibial and fibula bones (most commonly performed amputation)
• Symes: Amputation through Ankle
• Toe Amputation: removal of a toe
• Trans-metatarsal Amputation: amputation through the metatarsal
bones
• Lisfranc: Amputation of the metatarsals
• Chopart: Amputation of tarsals leaving the Calcaneus and Talus.
• Prigoff: Amputation of foot; calcaneus are put in the end of tibia for
weight bearing
PERI-OPERATIVE MANAGEMENT
CARE OF THE STUMP
• keep the stump clean, dry, and free from infection at all times.
• If fitted with a prosthesis, you should remove it before going to sleep.
• Inspect and wash the stump with mild soap and warm water every
night, then dry thoroughly and apply talcum powder.
• Do not use the prosthesis until the skin has healed.
• The stump sock should be changed daily, and the inside of the socket
may be cleaned with mild soap.
COMPLICATIONS OF AMPUTATION
• Haematoma • Neuroma
• Infections • Deformities of joints
• Necrosis • DVT
• Contractures • Bone overgrowth
• Phantom limb pain • PTSD / Depression
REHABILITATION
• Begin ASAP
• Goals – reduce edema, increase strength, prevent contractures,
maximize functional independence.
• Establish balance & coordination activities for gait training.
• Provide walking aids
• Also vocational training, pain management, psychological education.
PROSTHESIS
It is an artificial device used to
replace or augment a missing or
impaired body part
It is a replacement or substitution of a
missing or a diseased part
Types of Prosthesis
1. ENDOPROSTHESIS: It is placed inside the body eg; AUSTIN
MOORE PROSTHESIS
2. EXOPROSTHESIS: It is externally placed to cover the body part
eg. External limb
Factors to consider when prescribing a
prosthesis
There are many factors to be considered when a new prosthesis is
prescribed, including :
Weight bearing
Suspension
Activity level
General prosthesis structure
Components
Expense
Certain unique considerations.
NURSING DIAGNOSIS FOR
AMPUTATION
ANY QUESTIONS?
