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Below Knee Amputation

Published on Nov 19, 2015

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PRESENTATION OUTLINE

1.

PRE-OP DIAGNOSIS

  • Peripheral Arterial Disease(PAD)
  • Diabetic Ulcers/ Infections
  • Bone or Bone Marrow Tumor
  • Trauma
  • Congenital Defect
2.

PRE-OP TESTING

  • Standard X-Rays
  • H&P
  • Blood Tests
  • Angiogram
3.

POSITIONING/PREPPING

  • Supine
  • Webril w/Tourniquet
  • Cover Infected Portion of Leg
  • Incision Site to Groin Fold
  • Circumferential
4.

DRAPING

  • Impervious Stockinette
  • 3/4 Sheet or Split Drape
  • Extremity Drape
5.

EQUIPMENT/ INSTRUMENTS

  • Basic Ortho Tray
  • Power Saw w/ Oscillating Blade
  • Nitrogen Tank or Batteries
  • Liston Amputating Knife
  • Gigli Saw
6.

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  • Satterlee Bone Saw
  • Large Bone Hook
  • Tourniquet and Insufflator
  • Culture Tubes
  • HemoVac
7.

MEDICATIONS

  • Antibiotics
  • Anti-Nausea
  • Patient Controlled Analgesia
  • Stool Softeners
8.

PROCEDURE

  • Mouth of Fish Incision
  • Mark made on Periosteum to serve as Landmark
  • Two flaps formed
  • Kelly Clamp under Peroneal Nerve
  • Peroneal Nerve, Anterior Compartment Muscles, Anterior Tibial Vessels Divided
9.

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  • Tibial Crest Beveled
  • Tibia and Fibula Transversely Resected
  • Tibia Smoothed with Rasp
  • Irrigated
  • Tourniquet let down and Bleeding Controled
10.

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  • Gastrocsoleus Muscle Flap brought over ends of Bones
  • HemoVac Drain Placed
  • Skin Flaps sutured with Interrupted Non-Absorbable Suture
11.

POST-OP CONSIDERATIONS

  • Hospitalization 4-5 Days
  • Phantom Limb Syndrome may Occur
  • Drain Removed 1-3 days after Surgery
  • Dressing Changed 7-10 day Intervals
  • Stump Healed 3-4 weeks after Surgery

Brycen Bland