thigh amputation

Treatment of diseases: thromboangiitis obliterans arteriosclerosis 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: supine position. 2. Incision: Amputation of the knee, the incision scar is located in the same way as the calf amputation, and should be behind the stump. The ideal truncation plane is 25 cm below the top of the greater trochanter. The design of the flap should be short before the length (2:1), and the intersection of the flap in the side should exceed the truncated plane. After the incision, the fascia is separated, and the flap is turned up; or the rectus femoris flap with a thickness of 1 cm is separated, and cut at the same length as the anterior flap, and the flap is turned up. 3. Cut off the diseased limb: in the truncated plane, ligature and cut off the great saphenous vein. Separate the femoral artery, vein and saphenous nerve in the muscle of the sartorius or in the adductor, and cut and treat it according to the routine. Cut the muscles to the femur 2 to 3 cm below the truncated plane, cut the periosteum in the cut plane, cut off the femur, and disconnect the diseased limb. 4. Treatment of the posterior blood vessels and nerves: deep femoral and venous, and double ligation between the femur and the adductor muscle and the biceps femoris. Then the sciatic nerve was separated between the semitendinosus, semimembranosus and the biceps femoris, and it was gently pulled out. Procaine was injected in the proximal stage, and the nutrient vessels were ligated and cut off, allowing it to naturally retract. 5. Stitching: Loosen the tourniquet, completely stop bleeding, and put the rubber sheet to drain. The rectus femoris flap is turned down and sewed to the muscular septum or posterior fascia behind the femur. Intermittent suture fascia and skin. Proximal amputation should be performed with a vacuum tube.