An analysis of outcomes of reconstruction or amputation after leg-threatening injuries (original) (raw)
Related papers
2021
Background: Owing to advances in knowledge and technology, salvaging the limbs of patients with severe trauma and injuries is possible. However, severe limb injuries occasionally necessitate amputation because it allows patients to regain their social lives earlier than limb salvaging. Moreover, previous related investigations are retrospective cohort studies or meta-analyses of retrospective studies, and prospective cohort studies of patient-reported outcomes are extremely rare. This single-center, prospective cohort study aimed to compare the patient-reported outcomes at 1 year after injury between limb salvage and amputation and to elucidate whether amputation contributes to early recovery of functionality and quality of life.Methods: We included 47 limbs of 45 patients with severe open fractures of the lower limb and categorized them into limb salvage and amputation groups. They were registered in the Database of Orthopedic Trauma by the Japanese Society for Fracture Repair at o...
Limb Salvage Versus Amputation: A Review of the Current Evidence
Cureus, 2020
In the trauma situation where the trauma team is faced with a severely injured limb, it requires judicious thinking and evaluating not only the injury in isolation but the patient as a whole when considering the management options. The aim must be to give the best quality of life and avoid repeated admissions to hospital for associated complications in the future. The decision to amputate or salvage a limb should be based on numerous factors, such as the patient's pre-injury status, injury factors (soft tissue injury, location, contamination and physiological status), patient's wish and available resources. The biggest challenge when faced with a complex limb injury is deciding what management route to take with a satisfactory outcome for the patient being the main goal. Many studies have been undertaken looking at the outcome of successful limb salvage versus primary amputation. Studies such as the Learning Early About Peanut Allergy (LEAP) study have concluded that there was no difference of outcome at the two-year stage between the two strategies.
Factors affecting outcome after traumatic limb amputation
British Journal of Surgery, 2012
Background: Traumatic leg amputation commonly affects young, active people and leads to poor longterm outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation.
Journal of Orthopaedic Trauma, 2007
This review compared the outcomes of complex limb salvage surgery or early amputation in patients with severe legthreatening injury. The authors concluded that there are no significant differences in the functional outcomes of these patients, irrespective of the initial approach. The conclusions have to be viewed with caution since they are based on methodologically less rigorous studies. Authors' objectives To compare the outcomes of complex limb salvage or early amputation for severe leg-threatening lower limb injury. Searching MEDLINE, CINAHL and EMBASE were searched from inception to October 2006; the search terms were reported. Studies published in languages other than English were excluded. Study selection Study designs of evaluations included in the review Both prospective and retrospective observational studies were eligible for inclusion. Specific interventions included in the review Studies investigating limb salvage surgery or primary amputation were eligible for inclusion. Only one study reported the criteria for amputation rather than limb salvage; no further details of the interventions were reported. Participants included in the review Patients with severe leg-threatening injury were eligible for inclusion. Two of the included studies reported that the majority of limb salvage patients had a grade IIIB injury. Outcomes assessed in the review Inclusion criteria for the outcomes were not stated, but studies had to report data according to treatment group. The outcomes reported included length of hospital stay, total rehabilitation time, clinical outcomes, failure rates for limb salvage, function and quality of life, pain, return to work, factors associated with poor outcome, and patient preference. How were decisions on the relevance of primary studies made? Two reviewers applied the inclusion criteria independently and resolved any differences by consensus. Assessment of study quality One reviewer recorded whether the study analysed the outcomes after adjusting for injury severity. Data extraction One reviewer extracted the data from eligible studies. Methods of synthesis How were the studies combined? The studies were individually described and, where possible, the pooled relative risk (RR) and corresponding 95% confidence interval (CI) were calculated using a random-effect meta-analysis for some of the outcomes. How were differences between studies investigated? Statistical heterogeneity was assessed using the I-squared statistic. A value greater than 50% was considered to indicate significant heterogeneity.
Corrected: Limb Salvage Versus Amputation: A Review of the Current Evidence
2021
In the trauma situation where the trauma team is faced with a severely injured limb, it requires judicious thinking and evaluating not only the injury in isolation but the patient as a whole when considering the management options. The aim must be to give the best quality of life and avoid repeated admissions to hospital for associated complications in the future. The decision to amputate or salvage a limb should be based on numerous factors, such as the patient’s preinjury status, injury factors (soft tissue injury, location, contamination and physiological status), patient’s wish and available resources. The biggest challenge when faced with a complex limb injury is deciding what management route to take with a satisfactory outcome for the patient being the main goal. Many studies have been undertaken looking at the outcome of successful limb salvage versus primary amputation. Studies such as the Lower Extremity Assessment Project (LEAP) study have concluded that there was no diff...
Factors Influencing the Decision to Amputate or Reconstruct after High-Energy Lower Extremity Trauma
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
for the LEAP Study Group Background: Factors thought to influence the decision for limb salvage include injury severity, physiologic reserve of the patient, and characteristics of the patient and their support system. Methods: Eligible patients were between the ages of 16 and 69 with Gustilo type IIIB and IIIC tibial fractures, dysvascular limbs resulting from trauma, type IIIB ankle fractures, or severe open midfoot or hindfoot injuries. Data collected at enrollment relevant to the decision-making process included injury characteristics and its treatment, and the nature and severity of other injuries. Logistic regression and stepwise modeling were used to determine the effect of each covariate on the variable salvage/ amputation. Results: Of 527 patients included in the analysis, 408 left the hospital with a salvaged limb. Of the 119 amputations performed, 55 were immediate and 64 were delayed. The multivariate analysis confirmed the bivariate analysis: all injury characteristics remained significant predictors of limb status with the exception of bone loss; and soft tissue injury and absence of plantar sensation were the most important factors in accounting for model validity. Conclusion: Soft tissue injury severity has the greatest impact on decision making regarding limb salvage versus amputation.
Journal of Surgical Orthopaedic Advances, 2015
Battlefield injuries and high-energy civilian trauma present orthopaedic surgeons with treatment challenges. Despite efforts at limb salvage, some patients elect late amputation. This article reviews risk factors that predispose to late amputation. Using a MEDLINE search, English language peer-reviewed articles from 1993 to 2013 having data on late amputation following limb salvage were included. Late lower extremity amputation after limb salvage varied from 3.9% to 40% in civilian patients and from 5.2% to 15.2% in military patients. Factors influencing a patient's decision to undergo late amputation included a combination of complex pain symptoms with neurologic dysfunction, infection, a desire for improved limb functionality, and unwillingness to endure an often complicated and lengthy course of treatment. In military patients, rank was a significant risk factor since officers were 2.5 times more likely to elect late amputation (p < .05) than enlisted personnel. Despite often extraordinary efforts toward limb salvage, results may be disappointing. (Journal of Surgical Orthopaedic Advances 24(3): 170-173, 2015) Treatment of combat casualties with severely injured limbs is challenging, and the outcomes can be unpredictable (1). Traditional war wound epidemiology has changed as a result of modem body armor, which has decreased lethality from thoracoabdominal wounds, with resultant improved survival with mutilating extremity injuries (2). Limb salvage in this patient group is often difficult, outcomes can be unpredictable, and sometimes amputation is the end result. A recent study found that for the Iraq and Afghanistan Wars, 5.2% of seriously injured U.S. casualties underwent major limb amputation and that the vast majority (95%) ofthe·se amputations were performed early in the medical evacuation chain before reaching definitive care and not the result of later limb reconstruction (3). There is a small subset of patients who sustain severe battlefield injuries that result in salvage of a major limb, who later elect to undergo amputation after surgical treatment and rehabilitation. Historically, little has been known about the incidence of, risk factors for,
Traumatic limb amputations at a level I trauma center
European Journal of Trauma and Emergency Surgery, 2011
Introduction The purpose of this study was to analyze the epidemiology and outcomes after traumatic amputation of the upper (UEA) and lower (LEA) extremities. Methods The Los Angeles County ? University of Southern California Medical Center trauma registry was utilized to identify all patients sustaining traumatic amputation during the years 1996-2007. The demographics, mechanism of injury, clinical characteristics, associated injuries, surgical procedures, complications, and outcomes were obtained for these patients. Results During the 12-year study period, 130 patients suffered limb amputation, accounting for 0.25% of all trauma admissions. Thirteen patients (10%) were excluded because they were transferred from another facility after amputation or died in the emergency department. Of the remaining 117 patients, mean age was 38.1 ± 16.4 years and 77.8% were male. The predominant mechanism of injury was automobile versus pedestrian (27.4%), followed by work-related accidents (23.9%). Patients struck by vehicles were more likely to suffer LEA (93.8% versus 6.2%, p \ 0.001), while patients with work-related accidents were more likely to sustain UEA (81.5% versus 18.5%, p \ 0.001). Only nine patients underwent reattachment, all of which were for UEA and unsuccessful. Overall, 24.8% developed a complication during their hospital course, 55.2% of which were extremity related. Overall mortality was 3.4%, primarily attributed to associated severe traumatic brain injuries and thoracic injuries. Patients with LEA had longer hospital and intensive care unit (ICU) length of stay; however, after adjusting for confounders, this difference did not reach statistical significance (adjusted mean difference: 2.1 and 1.2 days, p = 0.69 and 0.79, respectively). A higher percentage of patients with LEA required discharge to a skilled nursing facility or rehabilitation center when compared with patients with UEA (29.6% versus 4.8%, p = 0.001). Conclusions Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.