Chapter 65 - Amputations.

Question 1

Can you name the indications mentioned in Tobias for (limb)amputation (6)? Also can you think of
animals in which amputation might not be indicated because severe ambulation problems could be
expected (3)?

Answer 1

1. Soft tissue or bone neoplasia located in a limb in which the neoplasm is not resectable without
   amputation or when amputation is the best or only way to provide wide excision.
2. Severe trauma to bones, joints or soft tissues where the trauma is not treatable or treatment
   would be otherwise cost prohibitive for the owners.
3. Peripheral nerve problems that render the limb nonfunctional (neoplasia or trauma leading to
   avulsion of a nerve root).
4. Ischemic necrosis following trauma or thrombosis.
5. Intractable orthopedic or soft tissue infection of the limb.
6. Severe disability due to unmanageable osteoarthritis or congenital deformity.

Contra-indication to amputation: obese animals, animals that have advanced osteoarthritis in the
other limbs or neurologic disease.

Question 2

You perform a pelvic limb amputation because of neoplasia. Should you ligate the artery or vein first?

Answer 2

The vein in order to limit the possibility of metastasis during surgical manipulation.
When a amputation is performed because of other reasons than neoplasia, the artery should be
ligated first to prevent pooling and loss of blood in the tissues of the limb.

Question 3

What long-term complication could you think of when you perform a amputation of the thoracic limb
by disarticulation of the limb at the shoulder joint?

Answer 3

The remaining muscles of the limb will atrophy, which can predispose the bony prominences of the
scapula, particularly the acromion to create pressure sores.

Question 4

What is the advantage of making the incision according to the
black arrowhead when performing a thoracic limb amputation?

Answer 4

Less risk of development of avascular necrosis of the tip of the
skin.

Question 5

You have performed a thoracic limb amputation by removal of the scapula. How would you (in short_
close the muscular defect?

Answer 5

• Apposing the cervical and thoracic portions of the trapezius muscle at the most dorsal
  aspect of the surgical bed.
• The more ventral portion of the cervical portion of the trapezius, omotransversarius and
  brachiocephalicus muscles are sutured to the latissimus dorsi muscle.
• The pectoral muscles are pulled dorsally and apposed to the ventral border of the
  latissimus dorsi and brachiocephalicus muscles.

Question 6

Acetabulectomy is performed when neoplasia affects the femoral head and/or head and when it is
necessary to obtain larger soft tissue margins. It could also be advised to perform this procedure in
case of proximal femoral osteosarcoma. Do you know why?

Answer 6

Osteosarcoma rarely crosses a joint, but it is known to cross the hip joint. This is presumed to
result from the fact that the ligament of the head of the femur which penetrates the articular
cartilages, acts as a bridge that allows the osteosarcoma to traverse the articular cartilages and
joint space.

Question 7

When performing a pelvic limb amputation by disarticulating the hip joint, the femoral artery and
vein are ideally ligated proximal to 2 significant branches. Do you know which branches?

Answer 7

Superficial circumflex iliac artery and vein and the lateral circumflex femoral artery and vein.

Question 8

What is the major difference in surgical technique between disarticulation of the hip joint and
acetabulectomy except for the osteotomy in the body of the ilium and the ischium and pubis?

Answer 8

The muscles that originate from the pelvis or sacrum and insert at the proximal femur; gluteal,
gemelli, internal and external obturator, piriformis, articularis coxae, quadratus femoris, adductor
longus mucsles, are not transected at the level of their insertion at the proximal femur, but closer
to or elevated from the ilium, ischium, pubis or sacrum in order to permit excision of the
acetabulum.

Question 9

True or false?
1. Compared to quadruped dogs, the vertebral column, carpus, ipsilateral hip and stifle joints had
significant biomechanical changes after amputation of a thoracic limb.
2. Pelvic limb amputees adjusted through increased range of motion at the tarsal joint, decreased
range of motion in the cervicothoracic and thoracolumbar vertebral regions.
3. There is no reported significant different adaptation time between thoracic and pelvic limb
amputees.

Answer 9

1. True
2. False
3. True

Question 10

Could you think of reasons that a patient experiences pain after the recovery from an amputation
according to Tobias?

Answer 10

1. Recurrence at the amputation site in cases of neoplasia
2. Cervical intervertebral disc herniation in thoracic limb amputees, because of increased stress on
   the cervical vertebral column caused by had motion
3. Neuroma
4. Phantom pain when animals experience paroxysmal behavior changes compatible with pain but
   in the absence of a pain response during orthopedic and neurologic examinations.

Question 11

What are reported complications of intraosseus transcutaneous amputation prosthesis (2)?

Answer 11

Aseptic loosening
Fracture of the prosthesis

Question 12

What is the definition of a partial foot amputation?

Answer 12

En bloc amputation of two adjacent digits with or without the corresponding metacarpal or
metatarsal bones.

Question 13

True or false?
1. Function following partial foot amputation is good to excellent, even when both weight-bearing
digits have been amputated together.

Answer 13

1. True