Reputatsia

Reputatsia (repeated amputation) - amputation stump limbs. Indications to reamputation serve different defects stump (see)preventing prosthetics (see) - a vicious form (conical stump hips, shank stump long peroneal bone, vastanie bones directly under the skin and others), inappropriate length stump, persistent sores on the cult, incorrectly located rough, painful and welded with bone scars, limit osteomyelitis, exostosis and some other pathological processes.
When preparing the residual limb to the prosthesis reputatsia is an extreme measure and is made in case of the failure of the other conservative and surgical methods of treatment. Reputatsia done in healthy tissues in compliance with all the basic rules and techniques amputation (see) and consideration of the peculiarities of the subsequent prosthetics. To get full stump very important that after reamputation the wound healed without suppuration, primary intention. Therefore, reamputation produce, as a rule, not earlier than one year after the amputation, when completely disappeared inflammatory changes stump.
Contraindications to reamputation are the reduction of protective forces of an organism after heavy infectious diseases, drastic, patients with inflammatory processes, pustular lesions. With the exception of patients with persistently healing ulcer stump, with purulent sinuses at the end osteomyelitis that cannot be either conservative or surgical treatment, speeding up the healing. In these cases, resort to reamputation, despite the presence of purulent.
Reputatsia can be performed under General or local anesthesia depending on patient's condition and the complexity of the operation. After reamputation (until the sutures are removed) stump immobilized using a plaster splint. Then appoint massage, and therapeutic exercises, directed on restoration of the tone of muscles and mobility in the upper parts of the joints.
Reputatsia in combination with rational prosthesis provides good functional results in defects stump.

Reputatsia (reamputatio; from lat. consoles re - again and amputatio - cut-off) - repeated amputation.
If reamputation cross the skin, subcutaneous tissue, muscles and bone (bone). Reamputation usually produce about a vicious stump (see) in order to make a stump convenient for prosthetics. Of all surgical interventions on the cult of reputatsia should be a last resort, to which should be used when other active and conservative treatment does not give the desired result. The main reasons for reamputation are: long-term healing of ulcers at the end of the stump, do not respond to medical treatment and surgery (Fig. 1); trophic disorders at the end of the stump preventing prosthetics; sharp vastanie the end of the bone (or bones), which severely stretched the skin or tripe, periodically torn or izyaslavs (Fig. 2 and 3); excessively long or short stump, difficult or impossible prosthetics.
Whenever possible, reamputation used incisions in the skin type Loskutov, vykraivaya front or rear flap or both together. Clipping muscles are producing at a rate filing, or slightly below, so you can sew on OPROM. Nerves, no pulling, cut off a sharp knife or the razor probably above. If the nerve is sealed, it should be distinguished from the surrounding tissue. On the blood vessels impose only kedgotoline ligatures avoid ligature fistulas. Bone filing process a chisel and a rasp, leaving sharp edges or ridges. It is not recommended to remove the periosteum. Filing bones should always close the fascia on the leg or taken freely. A skin scar come to the end of the stump on the front or back surface (depending on specific conditions).
Not recommended during reamputation to impose a plait, as it causes spasm of small vessels. The vessels begin to SIAT, and under the skin hematomas are formed. Some time after suturing spasm passes. After the operation, the dressing should not be earlier than two days (if for smooth until the sutures are removed).
Stitches should be removed not earlier than 12-14 days after reamputation (especially in the lower extremities). Prevent contractures of the lower limbs after reamputation need a bandage on a stump at full extension in the knee joint, and at short residual - back plaster of Paris splint is placed. In the bed under the stump should not be put pillows, cushions. Reamputation can be made under any anesthesia. Start reamputation only when all of inflammation disappeared, rubbing healed, swelling.
Contraindications to reamputation are: severe General condition of the patient, the presence of inflammatory processes on the cult, furunculosis, a short time after the primary amputation (less than 6 months), especially about anaerobic infections.

Fig. 1. Conical stump hips with painful scar and ulcers at the end.
Fig. 2. Irrational shank stump with wystawiam the end of bones, skin tightening the scar.
Fig. 3. Irrational shank stump: fibula much longer tibial.