Shoulder girdle amputation

1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Treatment of diseases: malignant tumor arterial embolism Indication 1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Contraindications 1. The blood coagulation mechanism has serious obstacles. High blood pressure, diabetes, and some bleeding-prone diseases. 2. Liver and kidney function is very poor. 3. The patient is too old and should be filled with poor general condition. Preoperative preparation 1. Amputation will bring severe mental and physical trauma to the patient. Therefore, the patient and his relatives should be explained in detail about the necessity of amputation and the problems in the assembly and use of the prosthesis. In the case of an open amputation, it is necessary to state that the amputation must be performed again. 2. Patients who are amputated after an open amputation are best to wait for the wound to heal after surgery; if they are not healed, they should be skin grafted first. 3. Except for those who have necrosis due to insufficient blood supply, all amputations should be placed on the proximal end of the truncated plane to inflate the tourniquet to reduce blood loss and keep the field clear. 4. In general, patients with high amputees should be prepared for blood transfusion before surgery to prevent shock. 5. Various special circumstances, such as diabetes, malignant tumors, etc., should be controlled with insulin or anti-tumor drugs before and after surgery. Surgical procedure 1. Position: The lateral position, the disease side is on the upper, fixed torso. 2. Incision: The incision is large and should be carried out in two phases. The side (neck and shoulder scapula) incision, from the inner end of the clavicle, along the bone outward, bypassing the shoulder peak to reach the sacral fold, and then down the scapula sacral edge down to the lower corner, bending 5 cm away from the spine; The anterior (thoracic) incision, from the middle part of the clavicle, descends along the outer edge of the deltoid muscle and the intermuscular sulcus, and is connected to the posterior incision by the posterior 1/3 of the anterior and posterior aspect of the scapula. The above incision should first be marked on the skin with methylene blue. 3. Cut the posterior muscle: first cut the incision, separate the middle and outer segments of the clavicle under the periosteum, and open the posterior flap. The scapula spine is bluntly separated, the latissimus dorsi, the trapezius muscle, the scapularis muscle, the large and small muscles, the anterior serratus and the scapula. Hemostasis, ligation (or suture) while cutting, pay attention to the transverse and scapular transverse artery branches. The scapula should be opened when the serratus is cut. 4. Treatment of nerves and blood vessels: Saw the wire in the inner part of the clavicle and cut off the subclavian muscle. When the upper limb is lowered forward and downward, the brachial plexus and the subclavian artery and vein are drawn, and they are treated as usual, cut off, and allowed to retract. 5. The anterior incision and the anterior muscle were cut: the anterior incision was made and the anterior flap was opened. The chest and small muscles are exposed and separated, and they are cut off near the stop points of the tibia and condyle, respectively, and the limbs can be disconnected. 6. Stitching: After flushing the wound, after completely stopping bleeding, a negative pressure drainage tube is placed, and the free muscle ends are sutured to cover the lateral chest wall. Then layered stitching. Pressure wound dressing. complication Phantom limb pain: also known as limb hallucination pain, refers to the limbs where the subjective feeling has been cut off still exists, and accompanied by severe pain, and the pain appears at the distal end of the broken limb, which is actually an illusion phenomenon.

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