Elbow Disarticulation Amputation

Published on 11/04/2015 by admin

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Last modified 11/04/2015

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CHAPTER 73 Elbow Disarticulation Amputation

AMPUTATION SURGERY

Controversy exists whether to perform a long transhumeral amputation or an elbow disarticulation. Amputation surgery should be viewed as a reconstructive procedure. The basic principle of all upper limb amputations is preservation of maximal length consistent with optimal function, control of disease, and satisfactory surgical wound management. Adherent scarred distal tissues or redundant soft tissue should be avoided.

BONE

Through-elbow amputation is carried out as a true disarticulation (Fig. 73-1). Minor contouring of the margins of the distal humerus is usually required to eliminate sharp condylar prominences. For above-elbow amputations, the bone edges should be slightly beveled so that there are no sharp prominences or rough bone edges.

ACUTE POST-AMPUTATION MANAGEMENT

Following surgery, the goals of the preprosthetic period are to

Immediate and early postsurgical prosthetic fitting provides edema control, pain reduction, and protects the surgical incision.14 Successful prosthetic use is higher when fitting is completed within a “golden period” of 30 days after surgery.14 If prosthetic fitting and training are delayed, the patient can become adept at one-handed techniques, making it difficult to incorporate a prosthesis in their daily living activities. A second study has shown that even delayed fitting can be successful.22 Common reasons for rejecting a prosthetic limb include the perception of limited usefulness, excessive weight, and residual limb pain.

An early postoperative prosthesis using a plaster cast or a high temperature thermoplastic socket typically can be fit by the third day after surgery. Prepositioned or self-positioned locking elbows are used to avoid excess elbow motion and shearing along the surgical incision. If there is concern about healing of the surgical incision, a stump protector (rigid removable dressing), compressive dressing, or soft dressing can be used until the incision has healed and the patient is ready to be fit for their first definitive prosthesis.