Amputation

Amputation have four aims
1. The removal of all diseased tissue
2. The relief of pain
3. Primary healing of the amputation wound is desirable
4. Construction of a stump that will permit the most useful function with or without prosthetic fitting is most consequential in functional patients.

Level of amputation
is determined by assesing the healing of the limb in association with the functional potential of the patient. Technical decissions regarding amputation level are based on adequacy of blood flow, extent of tissue necrosis, and location of tumor. Circulatory status may be ditermined by measurement of the peripheral pulses and the capilary refill time and by noting the presence of rubor, the conditon of the skin, and the presence of ischemic atrophy. Patient with ambulatory potential should be preserved in order to maintain nearly normal walking with the least of expenditure of energy. Transtibial prosthesis 10-40%, transfemoral 50-70%, crutches 60%.
A. Clinical examination:
palpable pulses: femoral pulse for above-knee, popliteal pulse for below-knee.
B. Measurement of blood pressure
doppler ultrasound and pneumatic cuff is a useful for determining the level of amputation.
C. Oxygen tension measurement
transcutaneus measurement use a modified clark-type oxygen electrode. If PaO2 above 40mgHg indicates that good healing, but intermediate values do not correlate closely with healing.