Name of the Procedure:

Amputation, thigh, through femur, any level; open, circular (guillotine)

Summary

An open, circular (guillotine) amputation at the thigh level involves surgically removing part of the leg through the femur to treat severely damaged or diseased tissue. This type of amputation is often a lifesaving measure.

Purpose

This procedure addresses severe trauma, infection, or malignancy in the lower limb that cannot be remedied through other treatments. The goal is to remove the diseased or damaged tissue to prevent further complications, including the spread of infection or cancer, and to save the patient’s life.

Indications

• Severe traumatic injury to the lower limb
• Advanced infection (such as gangrene) that does not respond to antibiotics
• Malignant tumors in the lower limb
• Severe peripheral artery disease leading to non-healing wounds

Preparation

• Patients may be required to fast for several hours before the surgery.
• Pre-operative evaluation includes blood tests, imaging studies, and cardiovascular assessment.
• Discontinuation or adjustment of certain medications like blood thinners may be necessary.

Procedure Description

1. Anesthesia is administered to ensure the patient is unconscious and pain-free.
2. The affected limb is cleaned and sterilized.
3. A circular incision is made through the skin and muscle down to the bone.
4. The femur is cut through at the desired level.
5. Blood vessels are tied off to prevent bleeding.
6. The wound is left open to heal by granulation or to be further refined in a subsequent surgery.

Tools, Equipment, and Technology:

• Scalpel, bone saw, clamps, cauterizing tools, and sutures.
• Use of sterile drapes and gowns to maintain a sterile field.

Anesthesia:

• General anesthesia is typically used for this procedure.

Duration

The procedure usually takes between 1 to 2 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeons specialized in orthopedic or vascular surgery
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Blood loss
• Blood clots
• Phantom limb pain
• Need for additional surgeries
• Cardiovascular complications

Benefits

• Elimination of diseased or damaged tissue
• Prevention of infection spread
• Potential lifesaving measure
• Improvement in overall health condition post-healing

Recovery

• Post-operative care includes wound care, pain management, and physical therapy.
• Hospital stay of several days to weeks might be required.
• Rehabilitation includes learning to use assistive devices like a prosthetic limb.
• Full recovery may take several months.

Alternatives

• Limb-sparing surgery (if feasible)
• Extensive debridement and use of antibiotics
• Revascularization procedures for improving blood flow

Pros and Cons of Alternatives:

• Limb-sparing surgery can preserve the limb but might not be appropriate for all cases.
• Extensive debridement may avoid amputation but can lead to prolonged recovery.
• Revascularization might improve blood flow but may not be effective in severe cases.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-operatively, patients might experience pain and discomfort managed with medications. Emotional and psychological support is essential as adjusting to amputation can be challenging. Pain management includes medication and therapy, focusing on patient comfort and mobility aid adaptation.