The Fourteen Steps Doctors Follow for a Supracondylar Amputation

The main objective of a supracondylar amputation is for the stump to heal properly and without complications so the patient can return to their normal life in the shortest possible amount of time and with the highest quality of life.
The Fourteen Steps Doctors Follow for a Supracondylar Amputation

Last update: 20 November, 2020

Supracondylar amputation is a surgical procedure to cut a pelvic limb above the condyle. Between 50% and 65% of these types of nontraumatic amputations are due to a diabetes complication.

A supracondylar amputation is performed when previous treatment to solve the problem has failed. This requires a process of acceptance and the formulation of a clear goal for the patient: protecting their health and ensuring the highest quality of life possible.

Thus, based on the above, the goal is a well-healed, stable stump that a prosthesis can be attached to as soon as possible. The ultimate purpose is for the patient to return to their normal life as soon as possible.

General principles

Antibiotic treatment is essential after a supracondylar amputation.

Generally, amputations are classified into major and minor. Supracondylar amputations are major, as they cover a large area. However, regardless of their classification, all amputations are complex procedures that must adhere to basic principles. These are:

  • They always involve antibiotic treatment to control a previous infection or as a preventive measure.
  • Hemostasis, or the process to stop bleeding, must be very rigorous. If bruising occurs, then it’s a sign of necrosis or infection.
  • There should be no tension in the entry points of the skin edges. To prevent this from happening, doctors need to carefully handle the soft tissues.
  • There should be a reasonable proportion between bone and skin and muscle-tendon length. This prevents tension and provides good bone coverage.
  • Performing traction of nerve pathways is important to prevent possible neurinomas in the scar.
  • The same must be done with the articular cartilage and tendons.
  • Preventing bone chips in the wound or sharp ridges.
  • Washing the surgical wound repeatedly with saline solution or sanitizer before closing.

Indications and contraindications

Doctors perform a supracondylar amputation when a previous infracondylar amputation failed to heal. Also, when there’s a contracture of the calf muscles, including a bending of the knee joint.

The knee joint is lost in a supracondylar amputation. To avoid complications with the prosthesis the patient will use, it’s important for the stump to have an adequate length.

This procedure isn’t recommended for patients with gangrene or a thigh infection.

Supracondylar amputation technique

Surgeons performing an amputation.

The goal of all amputations is to protect the patient’s health and improve their quality of life when other treatments have failed.

The steps doctors follow to perform a supracondylar amputation are:

  • Firstly, they place the patient in the supine position.
  • Then, they mark out a fish mouth incision.
  • After that, they cut the skin with a cold scalpel.
  • Doctors cut the subcutaneous tissue up to the aponeurosis, or the lining that covers the muscles and fixes them to the bone, with an electric scalpel. While cutting, doctors should leave enough tissue for the stump.
  • Then, they identify, isolate, and sever the superficial femoral artery and the deep artery of the thigh, as well as the sciatic nerve. It’s necessary for them to perform local anesthetic infiltration.
  • They surround the femur, covering its entire circumference.
  • After that, doctors separate the tissues attached to the femur. To do this, they need to use a periosteal elevator.

Final steps

  • Doctors should adjust the Percy amputation retractor in order to amputate the femur. This way, they’ll ensure that there’s enough soft tissue to cover the bone stump.
  • After that, doctors section the bone with a Gigli saw. They do this at a 90° angle between the two ends of the saw. While they’re doing this, they must constantly wash the area with saline solution.
  • Then, they file the bone edges.
  • After, they apply bone wax on the severed section. They press and set the bone wax on the severed section. The remains should be discarded.
  • After that, doctors close the stump with non-absorbable, sterile surgical sutures, known as Prolene. First, they suture the deeper muscle groups in order to cover the bone surface. Then, they suture the superficial aponeurosis.
  • Finally, doctors suture the skin with a silk suture using the vertical mattress stitch.
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  • García, L. H. (2009). Calidad de vida de los pacientes amputados de la extremidad inferior. Revista Médica de Costa Rica y Centroamérica, 66(589), 267-273.