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What is New in the World of Amputations?

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  1. What is New in the World of Amputations? William Gibbs, M.D., FAAPMR Medical Director Department of Orthopedics and Rehabilitation Medicine New York Hospital Medical Center Queens

  2. January 12,2010 Earthquake

  3. Some Haitian Rehabilitation Statistics • 200,000 Haitians will end up losing one or more limbs • 800,000 people were already living with disability before disaster • The few rehabilitation facilities that existed have largely been destroyed Sources: WHO/CNN/BBC

  4. Indications for Amputation • Remove malignant tumor • Treat severe infections • Treat end stage arterial disease • Remove a limb following irreparable trauma to extremity

  5. How to Determine Length? • Team approach • Determine amputation by the quality of tissue • Requirement s for prosthetic fitting • The upper extremity goal is to preserve as much limb length as possible.

  6. Evaluation • Evaluate skin, muscle , vascular supply, nerve function and bone integrity. • If vascular supply and sensation are lost, amputation is indicated. • Severe damage to three of the five major tissues (artery, nerve, skin, muscle • and bone) is an indication for early amputation.

  7. Guillotine Amputation Use of a guillotine amputation in emergency situations for contaminated Wounds or infection as a quick means of removing diseased or damaged tissue.

  8. Typical Amputation

  9. Shrinkage of residual limb

  10. Prosthetic Fitting

  11. Types of Prostheses

  12. Rehabilitation in Haiti Already in Progress: Albert Schweitzer Hospital in DesChapelles – in collaboration with The Hanger Foundation already has done 600 limbs Different groups working in silos giving fitting limbs Cuban physicians at the General Hospital

  13. Our Plan • Full Service AMHE Rehabilitation Institute • Inpatient Rehabilitation • Outpatient Rehabilitation • Orthopedic Surgery • Prosthetic Manufacturing • Physical therapy school • Prosthetic school

  14. How Will it Be Possible? • Funding/building Sources • AMHE Foundation • Holy Spirit Foundation – Dr. Pierre Paul Cadet, Chairman • APECQ – Association Patronale des Entreprises en Construction du Quebec • New York Dermatology Group Foundation • Helping Hands Bring Sunshine • LAHAF – Lend A Hand And Foot • AMHE Chapters – NY Chapter has started • Staffing • Greater New York Hospitals Association • American Physical Therapy Association – Rotations of therapists/Students • Rotations by members of the American Orthotic and Prosthetic Association