upper arm amputation

1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Indication 1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Preoperative preparation 1. Amputation will bring severe mental and physical trauma to the patient. Therefore, the patient and his relatives should be explained in detail about the necessity of amputation and the problems in the assembly and use of the prosthesis. In the case of an open amputation, it is necessary to state that the amputation must be performed again. 2. Patients who are amputated after an open amputation are best to wait for the wound to heal after surgery; if they are not healed, they should be skin grafted first. 3. Except for those who have necrosis due to insufficient blood supply, all amputations should be placed on the proximal end of the truncated plane to inflate the tourniquet to reduce blood loss and keep the field clear. 4. In general, patients with high amputees should be prepared for blood transfusion before surgery to prevent shock. 5. Various special circumstances, such as diabetes, malignant tumors, etc., should be controlled with insulin or anti-tumor drugs before and after surgery. Surgical procedure 1. Position, flap design and forearm amputation. Incision and subfascial separation of the flap [Figure 1]. 2. The nerves and blood vessels are treated to separate the median nerve, agitation, vein and ulnar nerve from the inner edge of the biceps muscle. The position varies depending on the plane [see the replantation of the broken limb (finger)) and is cut according to the conventional method. Generally, the suitable length of the upper arm stump is 13-20 cm. Within this range, the phrenic nerve has been wound around the posterior aspect of the humerus, which is difficult to separate in advance and can be treated after amputation. 3. The amputation cuts the muscle in a circular shape 1 to 2 cm below the truncated plane. If the upper arm is 1/3 amputated, the triceps tendon can be separated from the olecranon into a aponeurotic flap to cover the end of the bone. Cut the periosteum in the section of muscle retraction, saw the humerus, and cut off the diseased limb. Treat the phrenic nerve. Find deep movements, veins, and double ligation between the tibia and the triceps. Loosen the tourniquet, completely stop bleeding, and suture the fascia and skin after drainage. [Intraoperative Precautions] 1. When the upper arm is amputated, the length of the residual limb should be kept as much as possible. The ideal truncated plane is the humerus. 2. The medial cutaneous nerve of the forearm is quite large and easily confused with other nerves. It must be carefully identified during surgery. 3. If the amputation plane is too high, it is difficult to apply a tourniquet. When treating blood vessels and cutting muscles, the assistant should pressurize the armpit to prevent accidents and reduce bleeding.