27882 Amputation, leg, through tibia and fibula; open, circular (guillotine)

Name of the Procedure:

Amputation, leg, through tibia and fibula; open, circular (guillotine)

Summary

This procedure involves the surgical removal of a portion of the leg by cutting through the tibia and fibula bones using an open, circular method often referred to as the "guillotine" technique. This method allows for rapid amputation in emergency situations.

Purpose

The procedure addresses severe infections, extensive trauma, malignant tumors, or insufficient blood flow that cannot be treated through other means. The goal is to remove diseased or damaged tissue, alleviate pain, and prevent life-threatening complications.

Indications

• Severe infections (e.g., gangrene)
• Traumatic injuries beyond repair
• Advanced peripheral artery disease
• Malignant tumors
• Non-reconstructable limb traumatic injuries
• Severe limb deformities

Preparation

• Fasting for 8-12 hours prior to surgery
• Cessation of certain medications as advised by the doctor (e.g., blood thinners)
• Blood tests, imaging studies, and cardiovascular assessments
• Preoperative physical examination and consultation

Procedure Description

1. The patient is positioned, and the surgical area is sterilized.
2. General anesthesia or regional anesthesia is administered.
3. A circular incision is made through the skin and tissues down to the bones.
4. The surgeon saws through the tibia and fibula to complete the amputation.
5. Vessels and nerves are tied off, and the wound is left open temporarily for monitoring before closure in a later surgery.

Tools and equipment include scalpels, bone saws, and hemostats.

Duration

The procedure typically takes about 1-2 hours.

Setting

Performed in a hospital operating room.

Personnel

• Orthopedic or vascular surgeon
• Surgical nurses
• Anesthesiologist
• Possibly a surgical technologist

Risks and Complications

• Infection
• Excessive bleeding
• Phantom limb pain
• Poor wound healing
• Blood clots
• Need for further surgery

Benefits

• Relief from pain and infection
• Prevention of life-threatening complications
• Improved quality of life after recovery
• Potential for prosthetic limb fitting and increased mobility

Recovery

• Pain management with medications
• Wound care and dressing changes
• Physical therapy for rehabilitation
• Follow-up appointments for wound inspection and adjustment
• Expected full recovery time ranges from weeks to months, depending on the patient's condition and adherence to postoperative care.

Alternatives

• Vascular surgery for circulation improvement
• Limb-sparing surgery where applicable
• Antibiotic therapy for infections Each alternative has its own set of risks and benefits; the appropriateness depends on the specific medical circumstances.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-surgery, the patient will experience discomfort that is managed with pain medications. The initial period involves hospital stay for wound care and stabilization, followed by rehabilitation and physical therapy to adapt to changes and potentially prepare for a prosthetic limb.