CARE OF THE PATIENT WITH AN

AMPUTATION
DEFN-REMOVAL OF THE
DISEASED,NON
FUNCTIONING,PROTRUDING
BODY PART
-DERIVED FROM LATIN
WORD AMPUTARE
MEANING CUTTING
AROUND

Indications to Amputations
1. Trauma and its complications
(anaerobic infection,
osteomyelitis)


2. Malignant tumors of skeleton
and soft tissues of limbs


3. Vascular diseases
(thrombosis, diabetic
angiopathy, obliterating
endarteritis)

Classification of Amputations
Primary amputation (within first 24 hours)

Secondary amputation (7-8 days after
injury)

Re-amputation (repeated amputation)
Steps of Amputation
I. Cutting of soft tissue- All amputations are
divided into closed and circular amputation
in according to cutting of soft tissue.

II. Treatment of periosteum and cutting of
bone <A) aperiosteal B) subperiosteal>

III. Stump treatment-This stage includes
treatment of vessels, nerves and stitching of
soft tissues above the bone stump.
Types of Amputations

1. Flap amputations: Flaps are fashioned and are
closed primarily along with surgery.
- single-flap amputation
- double-flap amputation


2. Circular amputations:
- one-step (guillotine) amputation
All the tissues are cut at the same level.
Cutting of a bone on the same level.
two-step amputation (variety cuff
method of forearm amputation)
Soft tissues are cut in two motions (stages):
first skin, subcutaneous tissue, superficial
and proper faciae,
second cutting of muscles at level of
contracted skin.
Deficiency of this method is forming of a
scar at bearing or working surface of the
stump.


three-step (conical-circular)
amputation
As usual, this type of amputation is performed on
thigh or arm (where just one bone is present). In
this case soft tissues are cut in three motions on
different levels.
First step cutting of skin, subcutaneous tissue,
superficial and proper faciae.
Second step cutting of superficial muscles at
level of contracted skin.
Third step cutting of deep muscles.
As result of different levels cutting well have
cone-shaped stump with apex situated on bone-
stump.

Levels of Amputations
The most common complications of
amputation are:

massive haemorrhage that occurs when a suture
becomes loose
infection
rash, blisters, and skin breakdown caused by
immobility, pressure, and other sources of irritation
pneumonia, blood clots, and breathing problems
associated with immobility
formation of nerve cell tumors (neuromas) at
severed nerve endings
Chronic osteomyelitis caused by secondary
infection inside a wound

Phantom limb sensation
Feelings that the amputated part is still
present
Sensations of warmth,cold,itching,or pain
Caused by intact peripheral nerves
proximal to the amputation site that
carried messages between the brain and
the amputated part
Gradually decrease over the next 2 yrs
Osteo-plastic Amputations
(Gritti-Stokes and Sabanajeff amputations)
Pirogoff Amputation
Callander Amputation
(this gives an excellent end-bearing stump)
Below-knee Amputation
Amputation in Middle Third of Leg
Schemes of Foot Amputations
Syme Amputation
Sites of Election for Amputations of Upper
Extremity
Finger Amputation
Different Types of Prosthesis
Nursing Priorities
Support psychological and physiological
adjustment.
Alleviate pain.
Prevent complications.
Promote mobility/functional abilities.
Provide information about surgical
procedure/prognosis and treatment
needs.

First Aid
1. Check the person's airway (open if necessary); check
breathing and circulation. If necessary, begin rescue
breathing, CPR, or bleeding control.
2. Try to calm and reassure the person as much as possible.
Amputation is painful and extremely frightening.
3. Control bleeding by applying direct pressure to the wound.
Raise the injured area. If the bleeding continues, recheck
the source of the bleeding and reapply direct pressure, with
help from someone who is not tired. If the person has life-
threatening bleeding, a tight bandage or tourniquet will be
easier to use than direct pressure on the wound. However,
using a tight bandage for a long time may do more harm
than good.
4. Save any severed body parts and make sure they stay with
the patient. Remove any dirty material that can
contaminate the wound, if possible. Gently rinse the body
part if the cut end is dirty.
5. Wrap the severed part in a clean, damp cloth, place it in a
sealed plastic bag and place the bag in ice cold water.
6. Do NOT directly put the body part in water without using a plastic
bag.
7. Do NOT put the severed part directly on ice. Do NOT use dry ice as
this will cause frostbite and injury to the part.
8. If cold water is not available, keep the part away from heat as
much as possible. Save it for the medical team, or take it to the
hospital. Cooling the severed part will keep it useable for about 18
hours. Without cooling, it will only remain useable for about 4 to 6
hours.
9. Keep the patient warm.
10. Take steps to prevent shock. Lay the person flat, raise the feet about
12 inches, and cover the person with a coat or blanket. Do NOT
place the person in this position if a head, neck, back, or leg injury is
suspected or if it makes the victim uncomfortable.
11. Once the bleeding is under control, check the person for other signs
of injury that require emergency treatment. Treat fractures,
additional cuts, and other injuries appropriately.
12. Stay with the person until medical help arrives.
Nursing Care Plans
Anxiety
Desired Outcome: The client will openly
discuss feelings and reduced anxiety before
surgery.
Intervention: Establish open, honest
communication. Allow free expression of
fears and negative feelings about the loss
of a limb. Provide and reinforce information.
Prepare the client for phantom limb
sensation that their missing limb is still
present.

Delayed Surgical Recovery
Desired Outcomes: The risk of delayed surgical
recovery will be minimized.
Interventions: Clients with diabetes mellitus are a high
risk surgical group and require careful preoperative
assessment about their metabolic status.
Clients w/ ulcerated leg/osteomyelitis may be
treated with wound packing, antibiotics,and leg
elevation with bed rest.
Malnourished clients- given high protein diet and
supplements
Severely Anemic clients- given Iron supplements or
Blood transfusion
Dehydrated clients- should receive preoperative IV
fluids to restore fluid balance.

Knowledge Deficit
Desired Outcomes: The client will express an
understanding of the usual postoperative
regimen.
Interventions: Teach clients to
Exercising legs and arms several times a day
Strictly limiting weight bearing (for leg
amputation)
Learning the intricacies of stump and prosthesis
care
Mastering the use of prosthesis
Pain
Desired Outcomes: The client will express
understanding of the sensations present and
recognize that they are normaland usually
diminish in time.
Interventions: Emphasize that phantom
sensation is usual and, more important, subsides
in time. It is not helpful to correct clients by
telling them that the limb cannot be hurting
because it is absent.
Ineffective Individual Coping
Desired Outcomes: The client openly
verbalizes fears about the changes in body
image and loss of independence and
begins to speak optimistically and
realistically about the future
Interventions: Listen to the client. The client
may express concerns that it will be
impossible to return to a previous lifestyle,
including job, leisure activities, or intimate
relationships. With advancements in
prosthetic devices, many clients can have
both functional and aesthetic prosthetic
devices.
References:
Kent M. Van De Graff, Stuart Ira Fox, Karen
M. Lafleur. Synopsis of Human
Anatomy and Physiology /WCB
McGraw-Hill/, 2004.-675p
Philip Thorek. Anatomy In Surgery
/J.B.Lippincott Company/,1996.-935p.