Reamputation

REAMPUTATION, surgical correction of a defective stump (see Amputation). Such intervention is indicated for terminal osteomyelitis of the stump, growth of osteophites on it, painful neuromas, a large flat scar often adherent to the bone, and most frequently for the so-called conical stump, a stump shaped like a sugar loaf. The main cause of development of a conical stump, besides technically unsatisfactory amputation, is retraction and degeneration of the musculature; in children, in addition, there are conditions favorable to the development of the so-called 'physiological conical shape' of the stump, which is due to the relatively greater growth of the bone compared to the atrophied musculature. Therefore, in amputation in children, it is necessary to saw the bone relatively high and leave as much soft tissue as possible. Furthermore, the formation of a conical stump is contributed to by marginal necrosis from sutures, skin gangrene (ulcus prominens), and suppuration. Surgical correction of a defective stump consists in late high resection of the bone after its skeletonization. This is achieved in two ways: 1) by a new, higher amputation (secondary amputation) or 2) by excision of soft tissues in the form of a cone with sawing of the bone at its apex, calculated so as to close the bone without any tension with a thick layer of soft parts. If the musculature at the end of the stump has undergone scar changes over a considerable extent and there are painful neuromas, it is better to perform a new amputation or exarticulation. In the remaining cases, reamputation is indicated. The wound is freshened. The scar with part of the skin is excised. The soft parts are separated from the bone over the greatest possible extent; the muscles are fashioned into a cone. The bone is sawed by the periosteum-free method (according to Bunge) as high as possible (see fig.). It is necessary to strive to fashion the soft tissues so that the scar does not coincide with the center of the stump and thereby would be subjected to less trauma. A tourniquet should not be applied during the operation. Layered sutures must be applied so that the scar is not subjected to pressure from the bone, i.e., one should try to fashion the tissues so that the scar is placed AWAY FROM THE BONE.

A. ("irotknn."