What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

Amputation of the Leg - How dangerous is leg amputation?

The need to do an amputation is the physician's distressing admission of his inability to cure and is the single most distasteful operation that a surgeon has to perform.

Yet it is sometimes the only way to save a life. The reasons for amputation are usually severe injury or impaired circulation due to blood vessel disease. Today amputations are rarely necessary for infection. Amputations for cancer are occasionally undertaken as the only way to manage an otherwise hopeless problem. The sole consoling factor is that present day artificial limbs are well constructed, adjusted and fitted so that with them it is possible to get around very well and to perform virtually all functions. An observer will often not be aware of an artificial leg. It is a long way from the peg leg of Treasure Island's John Silver or the patient condemned to a wheelchair.

The results of the operation also depend on having good postoperative care by specialists in limb fitting, physiotherapists, and physicians who are specially skilled in rehabilitation and retraining techniques. This is another situation where direct contact with a successful recoverer of the same age can do much to strengthen the patient's drive for recovery.

The questions here apply to consultation regarding amputation for arterial disease.

Why can't it be left as it is? 

One can't do that because a part of the limb is already gangrenous that is, it is dead. If left alone the limb will become further infected, the gangrene will spread, and the individual will die. We have to remove the leg to save the life.

Why can't you just take off the gangrenous toes and leave the rest? 

That can only rarely be done because the area is infected and the tissues are so poorly nourished that they will never heal. The remaining part will not be suitable for walking or for the fitting of an artificial limb. Crudely put, there is no medical advantage, beyond sentimentality, in preserving these lower few inches of the leg. The patient will heal more rapidly and make a more efficient recovery if the amputation is performed at the proper level.

When will the amputation have to be done? 

As soon as it is evident that the part is dead and there is no possibility of reviving it. With the removal of the dead part, the patient's general condition can be expected to improve because there will no longer be pain, infection and the burden of the lifeless limb attached to the living body.

But aren't there other patients who have just the gangrenous toes removed? 

This is possible in those individuals whose disease is localized with only one or two toes undergoing dry gangrene, becoming mummified and falling off by themselves. Such individuals may have no important infection, no extensive arteriosclerosis of the blood vessels, and no destroyed tendon or bone. These parts have to have blood supply to be able to heal.

Where is the cut made? 

We try to do the amputation about four inches below the knee. There is an advantage to preserving the function of the knee joint. However, if it is presumed that these tissues will not heal or that the knee joint is already too stiff to function, then the amputation is done above the knee through the thigh. Healing at this site is almost always satisfactory.

Will I be able to walk after the operation? 

If you were able to walk before the operation, you should be able to walk afterward. The early fitting of an artificial limb and rigorous rehabilitation techniques are directed at making the patient function at least as well as he did before the operation. Completely rehabilitated patients walk without a cane. Others require a cane to help stabilize themselves.

Crutches are rarely required after the artificial limb is fitted. Realistically, the very elderly incapacitated patient (one who is partially blind, or who has had a stroke, or who has severe heart disease) will not be able to walk and will get about in a wheelchair. Certain adjustments in household and bathroom facilities will then be required. In still other individuals the sclerosis which resulted in the death of the leg, making the amputation necessary, is only one dramatic part of the general aging process. These patients can be best managed in a nursing home. The amputation in such instances is often the beginning of a slow but continuous downhill slide. The family always finds it hard to make an immediate realistic adjustment to such facts. With time the problem is seen in its proper perspective as it affects the patient as well as those closely associated with him.

Is there a danger that the other leg can become gangrenous too? 

Hardening of the arteries can occur anywhere. It is possible for the other leg to remain functioning, but it can also have arteriosclerosis. If this is going to happen, some signs of impairment generally appear within two years after the first leg has been amputated.

I read all about transplanting kidneys from dead people to those who need them. Can't this be done in the leg? 

Not yet anyway. Kidneys are necessary for life, and successful kidney transplantation requires the administration of drugs which can and do produce side effects. One can live successfully with one leg without the risks and uncertainties of a transplant. Transplantation of limbs is only in the experimental stage.

Lower Leg Amputation Surgery (Amputated Leg)


Is there any particular problem after this operation? 

One must be careful not to injure the stump. The scar can be a tender area, although the pressure of an artificial limb is not in this area. The other leg requires attention to avoid infection or injury. The care of toenails is particularly important, for an infection here can be the starting point of a catastrophe. One symptom of some patients is called "phantom limb" pain. They can still feel pain and sensation in the leg that isn't there. We don't know the explanation for this distressing phenomenon.

Can I drink alcohol? 

I like a drink before supper and at bedtime. I believe that it improves my appetite and helps me sleep. In these quantities and for this purpose alcohol can be beneficial. Alcohol, in small doses, is one of our best tranquilizers.

Can I continue to smoke? 

Most of the damage of twenty five years of cigarette smoking has already taken place. You have paid the price with the amputation. Theoretically, you should stop. From a practical point of view, though, if the outlook for survival is bleak, it probably is better to let you continue smoking rather than to endure the problems of withdrawal and the accompanying emotional frustrations.

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