REAMPUTATION (Latin re-the prefix designating retroaction, resuming, + amputatio cutting, cutting off) — the repeated amputation which is carried out for the purpose of elimination of defects or for the purpose of elimination of the diseases of a stump of an extremity which are not giving in to treatment taking into account the subsequent prosthetics. Less often R. make according to urgent indications, napr, concerning a recurrence of a malignant new growth in a stump or in connection with the bleeding caused by a necrosis.
Indications: not healing trophic ulcers of a stump; extensive soldered to a bone (easily vulnerable and ulcerating) the hems located on working surfaces of a stump; trailer osteomyelitis; not basic stumps of feet; excessively conic stumps with a high arrangement of the truncated muscles and a vystoyaniye opit bones under skin or a hem and other defects of a stump in various terms after amputation connected with disturbance of the technology of its performance or irrational prosthetics.
The separate group is made by the patients suffering obliterating defeats of vessels of extremities (see) because of an endarteritis, atherosclerosis and against the background of a diabetes mellitus. At them quite often after amputation in the next postoperative period discrepancy of skin edges of a wound, education in this area of a trophic ulcer and progressing of a sphacelism in fabrics are observed stumps of an extremity (see), as forms the basis for River.
Planned R. is contraindicated in the presence of the acute inflammatory phenomena and rezkopatogenny flora in tissues of a stump.
In all possible, cases instead of R. it is necessary to recommend reconstructive operations in combination with skin plastics (see) for the purpose of the minimum shortening of a stump. It is especially important at operations on a brush.
R. concerning a painful stump owing to involvement in cicatricial tissue of nerves or formation of neuromas in a hem, and also apropos is not shown osteophytes (see), complicating prosthetics. In these cases it is necessary to be limited to a resection of a nerve or removal of an osteophyte. At not basic stump feet (see), especially after amputation on average and proximal its departments (on Lisfranka, Zhobera, Shopara), osteoplastic operation on Pirogov is reasonable (see. Pirogova amputation ) or an artificial ankylosis of a pyatochnotaranny joint since the last are more reliable and favorable in the functional relation, than R. in combination with skin plastics.
Operation is made under anesthetic, local or intra bone anesthesia. Necessary conditions of R. are careful preparation of fabrics, use of a scrappy way at cutting out of skin, a fascia and muscles, separate mobilization and processing of vessels, nerves and a bone. At the end of operation are necessary a careful hemostasis putekhm bandagings of blood vessels and ensuring drainage of an operational wound. In all cases of R. at the level of a diaphysis of a bone it is reasonable to close bone opit muscles. The value of this method consists not only in increase in oporo-ability and functionality of a diaphyseal stump, but also in prevention of an excessive atrophy of a stump, and also a circulatory disturbance in it.
After R. it is necessary for providing an oporosposobnost of a stump that skin of a stump could maintain long loading, the stump had a big bearing area, tissues of a stump were painless, krovosnabzhatsya well, the end of a bone stump was equal and smooth. Increase in functional capacity of a stump after R. and preparation it to constant to prosthetics (see) are reached by early medical prosthetics or express prosthetics, use of LFK, massage, mekhano-and physical therapy.
See also Amputation .
Bibliography: Godunov S. F, Ways and technology of amputations. L., 1967, bibliogr.; L I am a N d r e with 3. A. Amputation and reconstructive operations on stumps of extremities at children, L., 1961, bibliogr.; Pavlova T. F. and Andruyeon M. V. Surgical preparation for prosthetics of patients with it is long not healing wounds of stumps of extremities, Ortop. and travmat., No. 10, page 26, 1972; The Guide to prosthetics, under the editorship of N. I. Kondrashin, page 117, etc., M., 1976; The Reference book on prosthetics, under the editorship of V. I. Filatov, page 55, L., 1978; H and C and V. D's N. Fundamentals of operational orthopedics and traumatology, page 271, M., 1964.
N. I. Kondrashin.