Complex Limb Salvage or Early Amputation for Severe Lower-Limb Injury: A Meta-Analysis of Observational Studies

Abstract

Functional outcome among patients who present with leg-threatening injuries are not significantly different, at least up to 7 years, whether they are managed with limb salvage or primary amputation. Research to optimize triage decisions to avoid failed limb salvage as well as on interventions targeting important psychosocial prognostic variables should be considered a priority.

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

“…Akula, et al, performed a meta-analysis investigating amputation versus limb salvage from the patient's perspective, and noted that reconstruction is psychologically more acceptable [1]. Similar to Busse, et al, they reported there, were no significant between group differences for functional outcomes [1,7].…”

“…More recently Doukas, et al (the METALS study) suggested that patients undergoing amputation had better functional outcomes than those undergoing limb salvage [11]. These findings are in contrast to Busse, et al, who performed a meta-analysis of observational studies comparing complex limb-salvage versus early amputation [7]. There was no difference between the two groups for functional outcomes at seven years, but the limb salvage group had a significantly longer rehabilitation time, more surgical procedures, and a higher rate of complications.…”

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

“…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]. A recent meta-analysis by Busse, et al did not observe significant differences for long-term functional outcome, return to work, and pain between patients undergoing limb-salvage or early primary amputation [7]. Regardless of the selected treatment modality, poor functional outcomes are consistently reported [2,7,24].…”

“…A recent meta-analysis by Busse, et al did not observe significant differences for long-term functional outcome, return to work, and pain between patients undergoing limb-salvage or early primary amputation [7]. Regardless of the selected treatment modality, poor functional outcomes are consistently reported [2,7,24].…”