Instructional course lectures
-
Certain factors regarding amputation level, such as the level of traumatic amputation, the position of a malignant tumor in a limb, or the level to which gangrene has progressed, cannot be changed. More important, in this regard, is the attitude of the surgeon toward amputation. This attitude determines the care with which the final level is selected, the manner in which the amputation is performed, and the way in which postoperative management, including prosthetic care, is handled. To achieve the desired long-term result for the amputee, the surgeon should view amputation as a reconstructive procedure rather than a destructive one, should be willing to do staged procedures to preserve potentially functional tissue, should be ready to consider and plan innovative surgical approaches, and should keep abreast of prosthetic advances as they affect surgical technique and postoperative management.
-
Pelvic ring disruption is part of a complex wounding pattern that challenges our ability to diagnose and manage hemorrhage. The conventional methods of diagnosis and control of abdominopelvic bleeding--peritoneal lavage and exploratory laparotomy--should be replaced by exploratory abdominopelvic angiography and transcatheter embolization. Angiography should be performed as soon as possible after the patient is admitted to the emergency room, and shock should not delay transfer of the patient to the angiography suite.