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
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
Indications for Amputation • Remove malignant tumor • Treat severe infections • Treat end stage arterial disease • Remove a limb following irreparable trauma to extremity
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.
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.
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.
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
Our Plan • Full Service AMHE Rehabilitation Institute • Inpatient Rehabilitation • Outpatient Rehabilitation • Orthopedic Surgery • Prosthetic Manufacturing • Physical therapy school • Prosthetic school
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