Syme Amputation

Sam's amputation is used for the surgical treatment of congenital femoral dysplasia. Congenital femoral hypoplasia, currently referred to as proximal femoral focal deficiency (PFFD). The incidence rate is 1 in 50,000 for live babies. Focal proximal defects of the femur include a wide range of defects, mild manifestations of mild femoral dysplasia, and severe cases of complete femoral dysplasia. The most common PFFD manifested as a partial skeletal defect in the proximal femur, instability of the hip joint, short-term deformity of the limb, and abnormalities in other parts. Most PFFD patients, especially those with bilateral lesions, are associated with malformations, such as humeral extremity deformity and knee cruciate ligament hypoplasia, congenital clubfoot, congenital heart abnormalities, congenital spinal dysplasia, and facial development. bad. Treatment of diseases: femoral head necrosis in children Indication Sam's amputation applies to: 1. Congenital femoral dysplasia, age 1 to 2 years old. 2. The affected femur is intact and the hip joint is stable. 3. Limb shortening deformity is serious, it is not appropriate to choose limb lengthening. Contraindications 1. The affected femur is incomplete and the hip joint is unstable. 2. Limb shortening deformity, should choose limb lengthening surgery. Preoperative preparation Regular preoperative preparation. Equipped with blood 200 ~ 400ml. Surgical procedure 1. Incision and exposure Make a fish-mouth incision, starting from the external iliac crest, over the back of the foot, stop at 1 cm from the inner iliac crest, and cut the subcutaneous tissue of the skin. The flap of the plantar portion should be of sufficient length to allow the skin incision to be sutured to the instep. The foot is fully deformed and has a horseshoe shape, which is convenient for revealing and cutting the front ankle joint capsule. Then, cut the ligament between the talus and the medial malleolus, but do not damage the blood vessels in the posterior part of the tibia. Cut off the lateral Achilles tendon. 2. Resection of the calcaneus and ankle joint The talus is clamped with a towel clamp and forcefully made into a horseshoe-foot shape to facilitate cutting the posterior portion of the ankle joint capsule, and the posterior side of the calcaneus is exposed through the subperiosteum of the ankle joint. The Achilles tendon was cut at the attachment of the calcaneus, and the heel was further pulled and flexed into a horseshoe foot. The soft tissue was removed and the entire calcaneus was removed and the ankle joint was broken. 3. Fixed heel pad Drill a hole in front of the distal end of the humerus and suture it to the aponeurosis at the distal end of the humerus with a thick wire from the distal side of the calcaneus pad. However, if there is a wider bearing surface for the extremity of the amputated limb, the distal cartilage should not be removed. The flexor tendon is pulled distally and then transversely cut and allowed to retract. Ligation of the anterior and posterior tibial arteries. 4. Close the incision A drainage tube is placed in the wound, and a full-thickness suture is used to close the skin incision. complication 1. Vascular injury in the posterior tibia. 2. Avascular necrosis of the flap. 3. The calcaneus pad is damaged.