Imaging of the Residual Limb after Amputation

Description

Amputation is considered a reconstructive procedure and, as such, the approaches and techniques of the surgery are designed to maximize the postoperative functionality of the residual limb and to receive a prosthesis when possible for restoration of locomotion. Although there are several important factors that influence the outcome of amputation surgery, of greatest consequence is the level of amputation ( eTable 112-1 ). The length of the residual limb has strong implications for postoperative rehabilitation and is decided by the need to eradicate pathology in the limb, the adequacy of the vascular supply, and length requirements for the fitting of a prosthesis.

A successful amputation surgery involves the appropriate management of all of the amputated tissue layers, including the skin, muscles, nerves, vessels, and bones. First, because the skin is the most important organ for wound healing, the greatest skin length possible is maintained, and the cutaneous scar is localized away from the weight-bearing area. Second, muscle is placed over the cut end of the bone with a myodesis to the bone or a myoplasty to give sufficient volume to pad the bone and ensure a good residual limb-prosthetic fit. Third, the nerves are transected under tension and placed in an environment proximal to the musculocutaneous scar of the amputation site, thereby reducing the possibility that a neuroma will form. Fourth, the larger arteries and veins are dissected and ligated to prevent the occurrence of arteriovenous fistulas and aneurysms. Fifth, bony prominences around the amputated bone are removed. Because ectopic bone formation can occur when the periosteum covering the bone that is retained is stripped, some surgeons prefer to resect the periosteum longer than the residual bone to adequately cover the bone end and deter ectopic ossification.