TOPIC 9. BASIC SURGICAL PROCEDURES – RESECTION, AMPUTATION AND TREPANATION
1. Resection
Resection is surgical removal of part or all of an organ, tissue or anatomical structure. It may be performed for malignancy, ischaemia, trauma, infection or irreversible dysfunction.
Examples: bowel resection, lung resection, liver resection and joint resection.
Types: segmental/partial, subtotal or total; wedge or anatomical resection depending on organ and disease.
Principles: define extent, preserve adequate blood supply to remaining tissue, achieve haemostasis, remove disease with appropriate margins, reconstruct continuity when indicated and send specimens for pathology.
Complications: haemorrhage, infection, leak from anastomosis, organ failure, adhesions, nutritional consequences and recurrence.
2. Amputation
Amputation is removal of a limb or part of a limb through bone or joint. It may be required when tissue is non-viable, infected beyond salvage, severely injured or affected by malignancy.
Indications
- Critical limb ischaemia with irreversible tissue loss or pain when revascularisation is not feasible.
- Severe trauma with an unsalvageable limb or life-threatening complications.
- Uncontrolled infection or wet gangrene despite appropriate treatment.
- Malignant tumour requiring limb removal when limb-sparing treatment is unsuitable.
- Selected congenital deformity or non-functional painful limb.
Types and levels
- Minor amputations include digits or part of the foot; major amputations include below-knee, above-knee and upper-limb levels.
- Choose the most distal level likely to heal while preserving useful function; assess perfusion, infection, tissue viability and rehabilitation potential.
- Guillotine/open amputation may be used in severe infection or contamination for source control, followed by reassessment and later definitive closure when appropriate.
- Definitive amputation aims for a well-padded, durable stump suitable for prosthetic fitting when possible.
Complications and rehabilitation
- Early: haemorrhage, wound infection, flap necrosis, wound dehiscence and venous thromboembolism.
- Late: neuroma, phantom limb sensation/pain, contractures, stump pain, skin breakdown and psychological distress.
- Rehabilitation includes pain control, positioning, range-of-motion and strengthening exercises, stump shaping, prosthetic assessment, gait training and psychosocial support.
3. Trepanation / trephination
Trepanation is creation of an opening in bone, classically the skull. In modern neurosurgery, a burr hole or craniotomy provides access to the intracranial compartment for diagnosis or treatment.
Indications: evacuation of selected intracranial haematomas, access for intracranial pressure monitoring or drainage, and other neurosurgical indications.
Burr hole: small circular opening made in the skull, often used for drainage or as an access point.
Craniotomy: a bone flap is temporarily removed and replaced after the intracranial procedure.
Craniectomy: a portion of skull is removed and not immediately replaced, for example decompressive craniectomy in selected cases.