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November 15, 2011
Amputation represents truncation of part of any body as a result of a surgery or an injury. The most widespread concept is an amputation of an extremity, that is its truncation within one or several bones. It is not necessary to confuse this term to an exarticulation – truncation of an extremity at the level of a joint. At amputation of a uterus this term is also sometimes used, however in this case more actual name will be a hysterectomy.
Amputation was carried out since the most ancient times, but not always on medical indicators. Very often in the history it is possible to meet cases when truncation of extremities was applied as punishment or torture. Hippocrates suggested to perform this operation within devitalized fabrics, after him Tsels came to a conclusion that it is necessary to take also a few healthy fabrics, such technique now just and is used. But in the Middle Ages all this knowledge was forgotten. Further the huge number of ways of treatment by means of bandaging of vessels followed, the osteoplastic surgery, etc. began to develop.
Amputations on time of commission can be divided into the following:
- Primary – as preprocessing. Share on early and late.
- Secondary – connected with the arisen complications
- Repeated – represent reamputations
In relation to a periosteum:
- Aperiostal – at this type of amputation leave 4 cm of a naked bone, and cross a periosteum and shift distally.
- Periosteal – distalny cut level dissect a periosteum, prokimalno delay that allows to hide obpit bones. This way thanks to elasticity of a periosteum is applicable only at children's age.
- Subperiosteal represent a look of which the bone saw cut covering that periosteum which was formed after a bone saw cut is characteristic.
By a method of truncation of fabrics:
- Scrappy – most often this technique is applied on a shin and a forearm. Can be one-scrappy and two-scrappy.
- Circular amputations represent a type of truncations on those extremities where fabrics of identical thickness from all directions. There is a set of subspecies of this technique depending on complexity of performance.
On a way of closing of a bone: in this case there is also a set of various methods, each of which is selected according to defeat physiology, its localization, a state of health of the patient, etc.
Now amputation is applied in exceptional extreme cases when development of a disease can do serious harm to health or even to lead to a lethal outcome.
Indications for carrying out procedure of amputation:
- Serious illness of vessels in combination with lack of their adequate treatment. Dry gangrene, acute ischemia of an extremity, a white phlegmasia – thrombosis of all veins and arteries of an extremity, a blue phlegmasia – thrombosis of venous trunks can be an example of such diseases. The decision on carrying out amputation is made together with the vascular surgeon. In that case when it is possible, instead of amputation can perform vascular reconstructive operation which is much less traumatic. But at irreversible ischemia amputation is the unique option.
- At purulent pathology in the severe form caused by anaerobic bacteria and which led to wet or infectious gangrene also amputation practically always takes place. The syndrome of diabetic foot is one of the most common causes of reduction of an extremity. It is connected with inflammatory process and local disturbance of work of vessels. The correct comprehensive treatment of this syndrome in half of cases allows to avoid amputation.
- As a result of a severe injury, for example, of the long pressure upon an extremity, amputation is made in rare instances, so the modern medicine found a way of recovery of an extremity other methods: medicinal, physioprocedures, etc.
- Malignant new growths can also become the amputation reason. Most often bring late stages of a carcinoma cutaneum, a melanoma, sarcoma, a teratoma, etc. to it.
- Orthopedic diseases which are not subject to correction can lead to reamputation.
Traumatic amputation is a separation or truncation of an extremity which resulted from an injury. This type of amputation is very life-threatening the person and can lead to a lethal outcome. In that case in time the provided first aid is vital. First of all for a stop of bleeding the plait above the place of a separation is imposed. After that it is necessary to take all possible measures for preservation of the amputated part of a body by its cooling. It will allow to recover a body part, but chances on recovery are not big.