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Amputation นพ.ไพศาล ดำขำ กลุ่มงานศัลยกรรมออร์โธปิดิกส์ โรงพยาบาลมหาราชนครศรีธรรมราช.

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Presentation on theme: "Amputation นพ.ไพศาล ดำขำ กลุ่มงานศัลยกรรมออร์โธปิดิกส์ โรงพยาบาลมหาราชนครศรีธรรมราช."— Presentation transcript:

1 Amputation นพ.ไพศาล ดำขำ กลุ่มงานศัลยกรรมออร์โธปิดิกส์ โรงพยาบาลมหาราชนครศรีธรรมราช

2 Definition Amputation
การตัดส่วนของแขน ขา หรืออวัยวะส่วนที่ยื่นออกจากลำตัว Disarticulation การตัดแขน หรือ ขา ผ่านข้อ

3 Indication Absolute indication
“Irrepairable loss of blood supply of disease or injuried limb”

4 Indication General indication - Severe limb injury - Life saving
- Congenital anormaly - Peripheral vascular disease - Chronic ulcer from nerve injury

5 Indication Children Adolescent and Adult Elderly Congenital anormaly
Trauma Work Malignancy Elderly Complication of peripheral vascular disease

6 Congenital club foot 1

7 Congenital club foot 2

8 Factor ที่มีผลต่อ Amputation
Patient Acception Choice of Amputation Early Ambulation Prosthesis

9 Upper extremity amputation
Hand & finger amputation Wrist disarticulation Below elbow amputation Elbow disarticulation Above elbow amputation Shoulder disarticulation

10 Level of Amputation in Wrist

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13 Level of Amputation in arm

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15 Crush Finger 1

16 Crush injury 2

17 Crush Hand 1

18 Crush Hand 2

19 Shoulder disarticulation
Humeral head True shoulder disarticulation Forequarter amputation 1.remove scapular 2.remove clavicle

20 Lower extremity amputation
Ray amputaion Midfoot amputation….Chopart / Lisfance Hind foot amputaion….Syme Below knee amputation Through knee amputation Above knee amputation Hip disarticulation

21 Level of Amputation in Leg

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26 Level of Amputation in Leg

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29 Level of Amputation through Knee

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33 Level of Amputation in Thigh

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36 Cancer 1

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38 Crush Ankle 1

39 Crush Ankle 2

40 Crush knee 1

41 Crush Knee 2

42 Stump Bandaging

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44 Complication Hematoma Infection Necrosis Contracture Neuroma
Phantom sensation

45 Hematoma Delay wound healing Good media for infection Treatment
Aspiration Firm compression

46 Infection DM or Peripheral vascular disease Treatment Drainage Culture
Appropriate antibiotic

47 Necrosis Minor skin necrosis Insufficient circulation
Conservative Severe skin necrosis More resection or Reamputation

48 Contracture mild to moderate severe appropriate stump position
gentle passive stretching strengthening exercise severe wedging cast surgical release

49 Neuroma On the end of a cut nerve Pain is caused by traction on nerve
Prevention Divide nerve cleanly at proximal part Allow nerve to retract Treatment Appropriate prosthesis Excise neuroma

50 Phantom sensation Meaning
Usually disappear after prosthesis application Rarely painful Treatment Drug Psychotherapy Transcutaneous nerve stimulation (TENS) or combination

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