11. M.E.S.S. (Helfet, CORR, 80, 1990) < 7 : Salvage 8-12 : Amputate

13. Congenital limb deficiency: Amputations for congenital limb deficiencies are performed primarily in the pediatric population because of failure of partial or complete formation of a portion of the limb. Congenital extremity deficiencies have been classified as longitudinal, transverse, or intercalary. Radial or tibial deficiencies are referred to as preaxial, and ulnar and fibular deficiencies are referred to as postaxial

19. Energy Expenditure for Amputation Amputation level Energy above baseline, % Speed, m/min Oxygen cost, mL/kg/m Long transtibial 10 70 0.17 Average transtibial 25 60 0.20 Short transtibial 40 50 0.20 Bilateral transtibial 41 50 0.20 Transfemoral 65 40 0.28 Wheelchair 0-8 70 0.16

21. Surgical definition and techniques Trans tibial – B/K Transfemoral – A/K Transradial – B/E Transhumeral –A/E

36. Joint contacture

45. SYME'S AMPUTATION The Syme's amputation provides an end-bearing stump that in many circumstances allows ambulation without a prosthesis over short distances. It is an excellent amputation for children, in whom it preserves the physes at the distal end of the tibia and fibula (26). The Syme's amputation works well for tumors and trauma, assuming that the heel flap has been spared from the trauma. In the past, it has had a high failure rate in ischemic limbs because of failure of wound healing. Today, the success of amputation at this level has increased because local tissue perfusion is preoperatively determined with Doppler ultrasound measurement of blood pressures, with radioactive 133 Xe clearance tests, and with transcutaneous measurement of oxygenation.

46. SYME'S AMPUTATION

52. Thank you