An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries

Bosse, Michael J.; MacKenzie, Ellen J.; Kellam, James F; Burgess, Andrew R.; Webb, Lawrence X.; Swiontkowski, Marc F.; Sanders, Roy; Jones, Alan L.; McAndrew, Mark P.; Patterson, Brendan M.; McCarthy, Melissa L.; Travison, Thomas G.; Castillo, Renan C.

doi:10.1056/nejmoa012604

Cited by 790 publications

(557 citation statements)

References 37 publications

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“…The psychosocial scores were 11.5 at 24 months, and 16.7 at 84 months [24]. Bosse, et al reported physical SIP scores of 10.1 and psychosocial SIP scores of 11.1 at 24 months for early amputations [5]. When comparing the results of this study to these earlier reports, the outcomes of delayed amputation for failed limb salvage surgery in this series are more comparable to early amputation.…”

Section: Discussionsupporting

confidence: 51%

“…These mean scores are substantially better than those reported by multiple authors for early amputation [5,8,24]. Akula, et al reported the mean physical scores for early amputation were 16.2, and 15.6 for the psychological SIP [1].…”

Section: Discussionmentioning

confidence: 68%

“…The outcome scores used in this study are validated and reliably measure function [3,30], disability, and mental health in a variety of diseases. These scores have been used by the LEAP investigators [5,7,[22][23][24][25][26], facilitating comparison with our results. This small cohort involved variable demographics, and had a broad range of injuries encompassing multiple different skeletal and soft tissue procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options include limb salvage, early, and delayed amputation [5,7]. The decision whether to reconstruct or salvage remains controversial [34].…”

Section: Introductionmentioning

confidence: 99%

“…Advances in orthopaedic, vascular, and plastic surgery have made it possible to treat severely injured lower limbs with salvage procedures [5,21]. However, limb salvage may not be in the patient's best interest as it is commonly associated with higher rates of rehospitalization, more surgical procedures, and a higher rate of complications when compared to primary amputation [7].…”

Section: Introductionmentioning

confidence: 99%

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Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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Purpose:The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. Methods:This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between between July 2006 and December 2014, with an age range between 18-80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Results:Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53+10 years were interviewed. Six patients had a SIP < 5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8+11.5 for the physical component, and 57.4+7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers.Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. Conclusion:The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

“…Treatment options include limb salvage, early, and delayed amputation [5,7]. The decision whether to reconstruct or salvage remains controversial [34].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma

Castillo¹,

Huang²,

Scharfstein³

et al. 2019

JAMA Surg

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IMPORTANCE Numerous studies have demonstrated that long-term outcomes after orthopedic trauma are associated with psychosocial and behavioral health factors evident early in the patient's recovery. Little is known about how to identify clinically actionable subgroups within this population.OBJECTIVES To examine whether risk and protective factors measured at 6 weeks after injury could classify individuals into risk clusters and evaluate whether these clusters explain variations in 12-month outcomes.

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Peripheral Vascular Trauma

Holena

Fox²

2012

Surgical Critical Care and Emergency Surgery

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An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries

Abstract: Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

Cited by 790 publications

References 37 publications

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma

Peripheral Vascular Trauma

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