Amputations versus Salvage: Reconciling the Differences

Abstract

Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

Risk Factors for Lower Extremity Amputation Following Attempted Free Flap Limb Salvage

“…Residual osteomyelitis and chronic pain are sequelae of limb salvage that have been associated with salvage loss. 23 Residual osteomyelitis was associated with secondary amputation in this cohort, further reinforcing the importance of proper debridement and infection control.…”

Multidisciplinary team meetings for patients with complex extremity defects: a retrospective analysis of treatment recommendations and prognostic factors for non-implementation

“…Patients preferred to get no therapy or insisted on the attempt of complex reconstructive procedures in the view of a rather low chance of success instead of limb amputation. However, postoperative functionality and survival benefit were critical factors in the decision-making process [18,19]. Thorough patient education is urgently needed to increase therapy adherence.…”

Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients

“…29 Although various different risk factors will influence the outcome, obtaining the best possible flow should be considered as an essential prerequisite for successful reconstruction. 30,31 In this series, relatively large flaps, such as anterolateral thigh (ALT) flaps, were used with the all flaps being large with average of 187.5 cm 2 to reconstruct the defect ensuring tensionless closure of the defect. Unlike the high percentage leading to higher level amputation after TMA either by secondary intension healing or primary closure, there were only two cases that led to higher level amputation in this study.…”