Above Elbow Amputation
General
- defined as any level from supracondylar region to axillary fold
- preserve as much length as possible
- note level of bone section should be at least 3.8cm proximal to joint to allow for prosthetic elbow mechanism
- amputations at or proximal to axillary fold require prosthetic fitting as shoulder disarticulation
- although preservation of most proximal portion of humerus is valuable for cosmesis (normal contour) & stability (prosthetic socket grasps humerus)
Supracondylar Area
- equal anterior & posterior flaps each being in length ½ diamater of arm at that level
- doubly ligate & divide brachial artery just proximal to level
- transect median/ulnar/radial nerves higher so ends retract well proximal to end of stump
- divide anterior muscles 1.3cm distal to level so retract to level
- free triceps from olecranon preserving as long flap
- incise periosteum circumferentially at least 3.8cm proximal to joint
- divide bone & round ends with rasp
- bring triceps over bone end & suture tendon to fascia over anterior muscles
- insert drain deep to fascia, close skin with interrupted nonabsorbable sutures
Proximal to Supracondylar Area
- as per supracondylar area but divide triceps 3.8-5cm distal to level, again suture to anterior fascia
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