1-51
1-51. THE SITE OF AMPUTATION
a. The exact location for the amputation of a limb is based on several factors. The physician will always strive to preserve as much of the limb as possible, but there are other considerations involved in the decision. For example:
(1) The blood supply available to the remaining limb.
(2) The functional ability of the remaining limb.
(3) The fitting of a functional prosthesis.
(4) The patient's age and overall physical condition.
(5) The patient's muscle strength.
(6) The patient's ability to learn.
b. The usual sites for amputation of a lower extremity include the foot, the ankle, below the knee (BKA), above the knee (AKA), at the hip (hip disarticulation), or at the pelvis (hemipelvectomy). Usual sites involved in amputation of part of an upper extremity include the fingers, at the wrist, below the elbow (BEA), above the elbow (AEA), and at the shoulder (shoulder disarticulation). The shoulder disarticulation, hip disarticulation, and hemipelvectomy are normally done only in cases of extensive injuries, malignancy, or gangrene. They are disabling and traumatic procedures, and done only as a last recourse.
c. Two basic types of amputation procedures are utilized. They are referred to as open, or guillotine amputation and closed, or flap amputation.
(1) The open amputation is performed when infection is present or likely to develop due to the circumstances of the injury or amputation. Tissue and bone are severed at the same level, and
the wound is not closed, but left open to drain. Bulky dressings cover the stump end.
(2) The closed amputation is the preferred method as it usually heals faster and allows the patient to be fitted for and begin using a prosthetic device much sooner. When the tissue and bone are severed, skin flaps are left to cover the stump end. Drains are placed in the wound and the skin flaps are sutured.
