Early versus Delayed Amputation in the Setting of Severe Lower Extremity Trauma

Abstract

Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

Amputation Following Burn Injury

“…Amputation in patients with severe injury to an extremity has been shown to improve survival. 8,10 Delays in amputation have been attributed to complications including infections, burn severity, and mechanism of injury. Furthermore, undergoing amputation results in additional rehabilitation needs and has long-term socioeconomic implications for patients and their families.…”

Key Points of Preliminary Treatment for Patients with Extremity Trauma Based on Analysis of Amputation Cases

“…It is more likely to expand the region of amputation operation or even cause serious complications which can threaten the safety of life. 15,16 Therefore, the medical staff should grasp the indications and make detailed communication with patients and their families.…”

Amputation in Trauma—How to Achieve a Good Result from Lower Extremity Amputation Irrespective of the Level

“…Unfortunately, systems such as the Mangled Extremity Severity (MESS) score have not proved to be helpful in determining which patients should undergo amputation and careful individualised decision making is advised [6,7]. Early amputation in appropriate patients has been shown to shorten hospital stay [5] and to lead to better function and perceived outcomes for the patient [8••].…”