Recently, I performed my first thoracic limb amputation. I had already performed a pelvic limb amputation, but a thoracic limb brought its own level of difficulty. The anatomy of each limb is very different, so I’m not sure why I did not initially realize how different each of the surgeries would be to perform. It was a good learning experience to get to participate in each surgery. I was also able to play a part in helping a little puppy get around on his own better and allow him more independence.
He presented for a limb amputation because he was born with a congenital abnormality that caused his front left limb to be fixed in a bent position at an inappropriate angle that prevented him from being able to bear weight on it. However, because it was still there, it impeded his balance and made it difficult for him to get around. By removing the affected limb, he would be able to balance better and walk with less difficulty.
One of the main difficulties of any limb amputation is discerning blood vessels from nerves. Nerves can be transected (or cut) as they are, but vessels (both arteries and veins) obviously require ligation prior to being cut. Ligation involves tying a suture around a vessel to occlude blood flow and prevent excessive blood loss once the vessel is cut. With larger vessels, especially arteries, ligation is extremely important, especially on the side of the vessel that will be staying with the animal. To ensure that the artery will not continue to bleed, we used a circumferential ligature that essentially tied a knot of suture material in a circle around the vessel and then followed that with a transfixing ligature, which involves a double ligation for even stronger vessel occlusion.
All of the surgeons I’ve worked with have told me that I’m the one that needs to sleep at night with my ligatures and knots. It makes it far more important to me to have confidence in how strong my knots are so that I know my patient will stay healthy and recover well following surgery. Now that I am the surgeon, I know the importance of owning the responsibility of keeping my patient safe and I will carry that with me into practice.
