APPROACHES AND AMPUTATION TECHNIQUES

Question 1

BRIEFLY DESCRIBE LOWER EXTREMITY FASCIOTOMIES IN THE LEG

Answer 1

2 INCISION 4 COMPARTMENT RELEASE
MEDIAL: 1CM POST TO MEDIAL TIBIAL BORDER FROM MEDIAL MALLEOUS TO MEDIAL PLATEAU: RELEASE THE SUPERFICIAL AND DEEP POSTERIOR COMPARTMENTS
LATERAL 1CM ANTERIOR TO FIBULA, AVOID SPN, RELEASE ANTERIOR AND LATERAL COMPARTMENTS ENSURING RELEASE BY IDENTIFYING THE LATERAL INTRAMUSCULAR SEPTUM

Question 2

THIGH COMPARTMENT RELEASES

Answer 2

3 COMPARTMENT RELEASE THROUGH 2 INCISIONS.
LATERAL:

Question 3

POSTERIOR MEDIAL APPROACH TO TIBIAL PLATEAU

Question 4

ANTEROLATERAL APPROACH TIBIAL PLATEAU

Question 5

POSTERIOR OPEN APPROACH TO THE TIBIAL PLATEAU

Question 6

Forequater amputation

Answer 6

• Interscapulothoracic amputation
  
  • Enblock removal of the upper extremity with scapula and lateral clavicle

Positioning:
- Lateral position with bean bag

Incision:
- Anterior :
○ 2cm lateral to SC joint, runs parallel to DP incision to below axillary hair
○ Extend skin flap to sternum
- Posterior:
○ Lateral to base of neck, curve out around lateral border of scapula
○ Extend skin flap to medial border of scapula

Removal of Limb:
- Anterior:
○ Detach pec major from clavicle
○ Osteotomize clavicle at proximal third junction
○ Identify and clamp subclavian vessels
- Posterior:
○ Detach scapular musculature:
§ Rhomboids, trap, levator, latissimus
○ Remove from chest wall
§ Detach serratus anterior and latissmus
○ Palpate chest wall for disease burden
- Connect posterior and anterior incisions through the axilla
- Transect brachial plexus
- Ligate vessels
- Remove limb

Reconstruction:
- Anteriorly based flaps use the pectoralis major as the primary muscle for closure, whereas posteriorly the trapezius is used.
Suture remaining muscles to lateral chest wall