Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital (original) (raw)
Related papers
Current Trauma Reports
Purpose of Review To provide an overview of patient management and surgical technique regarded as best practice in optimising outcome following primary and secondary amputation in trauma patients. This is supported by evidence where available. Recent Findings There is increasing evidence that primary amputation may offer superior outcome to reconstruction in severe open lower limb injuries, particularly segmental trauma involving the foot and tibia. Similarly, patients considering complex reconstructive procedures for failed trauma management should be counselled that reported outcomes are equivalent or better following amputation and are achieved faster and with less complications. Patients should be fully informed of this when making decisions about management, though this needs to be individualised. Various surgical techniques have been associated with improved outcome and these are described herein. Careful peri-operative pain management has been associated with faster rehabilitation, better psychological response and a reduced risk of chronic pain. On discharge, patients should be linked to rehabilitation, prosthetic and clinical psychology services and these should be integrated where possible. Summary A holistic, multidisciplinary approach is recommended in all aspects of care and should be available from the outset. Patients should be optimised medically and functionally, where possible pre-operatively. Psychological assessment and early information sharing are recommended. Where this is not possible due to acuity, these issues should be addressed as soon as possible post-amputation. Particularly where the limb is severely injured, careful planning and joint operating by senior Orthopaedic, Plastic and Vascular surgeons can achieve the best results.
East African Medical Journal, 2007
The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face. Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients. Design: A prospective study of post-traumatic primary limb amputations. Results: Sixty six traumatised patient limbs were primarily amputated during the study period.
Guidelines for the acute care of severe limb trauma patients
Anaesth Crit Care Pain Med, 2021
Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda- tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology. Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions: There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
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.
2017
Objective: To find out the epidemiology and in-hospital clinical outcome of post traumatic major limb amputations. Methods: This descriptive case series study was carried from February 2014 to June 2016. Life saving major limb amputations were performed in Accident and emergency Department (A & E) in patients of both gender and any age fulfilling the inclusion criteria. The demographic data and clinical data of mechanism of injury, level of amputation, associated injuries, Mangled Extremity Severity Score (MESS), postoperative stump wound infection, length of hospital stay and mortality were recorded. Patients were followed up till discharge from hospital. Results: A total of 82 patients(87 major limb amputations) with mean age 29 years (range 7 to 48 years) were enrolled in this study. Male patients were 77(93.9%) while female patients were 5(6%). Motor bike accident was accounted for the highest number of limb amputations (n=21, 24.1%) followed by sugar cane crusher machine (n=13,...
Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2013
The decision of either preserving a member or primary amputation (PA) in severe extremity trauma, especially in the presence of fractures, vascular injuries or serious injuries of soft tissues has always been a challenge for the trauma surgeon. The initial assessment with objective criteria like indexes, such as the Mangled Extremity Severity Score (MESS) or the PSI, can aid in the differentiation of members that can be saved or should be amputated primarily. We report on the design and preliminary results of our ongoing prospective study analyzing laboratory test as predictors of amputation in severe lower limb trauma. Materials and methods: All patients treated in our emergency department with severe lower limb trauma and open fractures (classified as Gustilo III) were included in this study. We collected blood for laboratory test of all patients at admission. All injured limb were photographed for posterior analysis and MESS classification. Results: From March 15, 2012, to June 10, 2012, n = 20 patients were included in our study. PA was performed in eight (40%) and preserving procedures (PP) in 12 (60%). Mean age was 30 in PP group and 40.5 in PA. Mean systolic pressure at the emergency room was 130 mm Hg in PP and 107 mm Hg in PA. MESS index was calculated for all patients and the means were 5 for the PP group and 8 for the PA group. Laboratory test of the two groups were compared and statistically analyzed. Acidosis, arterial lactate levels and hemoglobin levels at admission had a statistical difference between the two groups: pH = 7.36 PP vs 7.18 PA (p = 0.001); lactate: PP = 25 vs PA = 63 (p < 0.001); hemoglobin: PP = 13.6 vs PA = 7.85 (p = 0.03). Conclusion: Laboratory results of tests collected during initial assessment of patients with severe lower limb trauma are different between those submitted to PA or a PP.
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital
U pper limb injuries are injuries that may cause serious dysfunction, limb loss or death. [1] Due to their functional importance, they are among the pathologies with high morbidity rate leading to long-term loss of workforce. [2] It is extremely important to collect data regarding the attempts made in this degree of labor loss and cost loss injuries in the society, to determine the problems experienced in the postoperative period and to take necessary measures to eliminate these problems. In this study, we aimed to investigate the demographic features and etiological factors of upper extremity injury cases treated in the Plastic Reconstructive and Aesthetic Surgery Objectives: In this study, we analyzed patients with upper extremity injuries concerning patient demographics, injury type and etiological factors, and the most common problems encountered during the first 24 hours that were noted in the retrospective analysis. Methods: In this study, a total of 82 patients who presented to the emergency plastic surgery clinic in Şişli Hamidiye Etfal Research and Training Hospital, postoperatively these patients were checked after surgery for first 24 hours concerning pain, nausea and vomiting, edema, agitation, arm immobilization arm and vascular patency. Results: Among etiological factors, 54 patients were sharp-object trauma, 10 patients punched a hard object, 15 patients had work hazard, two patients had traffic accident, one patient from the fight. When these patients were postoperatively analyzed, in 45% patients pain, in 7% nausea and in 14 % bleeding were observed. Plaster was placed in 100% of the patients in order and their arms were elevated to reduce edema. During the first four hours, in 2% of the patients, edema was seen, 16% agitation, 8%vascular problems. Conclusion: When the type of injury is subcategorized to injuries of several compartments (nerve, tendon, muscle, artery, vein), the early postoperative challanges are more easily and correctly handled.
Lower limb amputation in trauma sequelae: choice of level and techniques
Lo Scalpello - Otodi Educational
The main purpose of amputation is to bring a specific patient, regardless of the initial scenario, to a new normality, characterized by the absence of pain and functional potential of the stump in terms of wearability and power. It is therefore implicit that the strategy is played on the choice of the level, using both analysis of the scenario of the patient and the perspective of the prosthetic project. Hence the delicacy of the choice of the moment and the level of amputation, considering multiple possibilities arising from evolution of surgical techniques, interdigitation of skills between traumatologist and plastic surgeon, translation of some techniques initially used for amputations of the upper limb to amputations of the lower limb, to substantial innovations in limb prostheses.
ACTES 2019 - Abstracts Book; The 3rd Albanian Congress of Trauma and Emergency Surgery
Albanian journal of trauma and emergency surgery, 2019
Albanian Journal of Trauma and Emergency Surgery is the official publication of Albanian Society for Trauma and Emergency Surgery-ASTES Structure and Format AJTES is an open access, peer reviewed periodical journal that includes editorials, reviews ,original articles, case reports, short report,ideasand opinions, bookreviews, perspectives, seminars , symposium and mini-symposium, ethics andrights, health care policy and management, practiceguides. The structure of each edition of the publication comprises section categories determined by Editor and reflects the views of the Editorial Board. Editorial Expertise Guidance from Editorial Board consists of leadingauthorities from a variety and respective fields ofmedical science. Peer review-accomplish by expertselected for their experience and knowledge of a specific topic.
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.