8. AMPUTATION SURGERY ON LIMBS. WAYS OF SOFT TISSUES TREATING DURING AMPUTATIONS, TENORRHAPHY

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Topics of the lesson: The concept of amputations, exarticulations. Classification of amputations. The main stages of amputations and exarticulations. Types of treating of vessels, nerves, periosteum, bone, myorrhaphy, tenorrhaphy, stump formation.

8.1. Give definitions.

Amputation is_

Exarticulation is_

8.2. Using the Fig. 8.1, name the possible soft tissues dissection methods.

Fig. 8.1. Soft tissue dissection during amputation

1. __

2. __

3. __

4. __

5. __

8.3. The thigh circumference is 24 cm. Calculate the circumference of the long flap during the amputation of the thigh in the upper third.

8.4. Fill in the table.

GRITTI-SZYMANOWSKI-ALBERCHT OSTEOPLASTIC THIGH AMPUTATION
Definition:_ _ _ _ _ _ _
Indications:
Special surgical set of instruments: 1. _ _ 2. _ _ 3. _ _ 4. _ _ 5. _ _

1. Stage - _ _ _ _ _ _ _	Describe the flap formation technique
2. Stage - _ _ _ _ _ _ _	Describe the technique of bone sawing, periosteum and patella treatment
3. Stage - _ _ _ _ _ _ _	Describe the neurovascular tracts treating technique
	Fasciae and muscles suturing _ _
	Skin suturing _
Limb immobilization

PIROGOV?S OSTEOPLASTIC FOOT AMPUTATION
Definition:_ _ _ _ _ _ _
Indications:
Special surgical set of instruments: 1. _ _ 2. _ _ 3. _ _ 4. _ _ 5. _ _
1. Stage	Describe the flap formation technique
2. Stage	Describe the technique of the leg bones sawing, periosteum treating and mapping of the heel bone
3. Stage	Describe the technique of the treating of anterior and posterior neurovascular tracts
	Fasciae and muscles suturing _Skin suturing _
Limb immobilization

GÜnther osteoplastic amputation
Definition:	Is -_ _ _ _ _ _ _
Features that distinguish this amputation from the Pirogov?s foot amputation	1.
	2.
sharpe foot amputation
1. Indications:
2. Cut out a skin flap from the remaining areas;
3. Treat the periosteum;
4. Saw the metatarsal bones at the base;
5. Cut out the plantar skin flap;
6. Treat the vessels and nerves on the rear and on the sole of the foot;
7. Cover the sawdust of the bones with a plantar flap
isolation of the foot in the tarsometatarsal (lisfranc?s) joint
1. Cut the rear skin flap out and pull it off proximally;
2. Bend the foot as far as possible towards the sole and medially, open from the 5th to the 3rd tarsometatarsal joints;
3. Open the I tarsometatarsal joint;
4. Cut the ligaments of the II metatarsal bone, open the Lisfranc?s joint fully;

5. Cut the plantar skin flap out;
6. Cut down the protruding area of the I sphenoid bone;
7. Treat the vessels, nerves of the rear and the sole of the foot;
8. Connect plantar and dorsal skin flaps

8.5. Describe the general principles of tendon suturing and the author's technique of tendon suturing, represented in the Fig. 8.2.

Fig. 8.2. Types of tendon sutures

General principles:_

Types of tendon sutures:

1. _2. _

3. _

4. _5. _

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