Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Krueger, Chad A.; Rivera, Jessica C.; Tennent, David J.; Sheean, Andrew J.; Stinner, Daniel J.; Wenke, Joseph C.

doi:10.1016/j.injury.2015.05.015

Cited by 29 publications

(9 citation statements)

References 43 publications

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“…However, the Military Extremity Trauma Amputation/Limb Salvage (METALS) study found better functional outcomes in patients with early amputation compared with limb preservation in a military population [3]. Krueger et al [8] found that the most common indications for late amputation after limb preservation were pain and dissatisfaction with the preserved limb. Others have found that late amputation was associated with patients who had severe soft tissue injury requiring flap coverage, postoperative courses complicated by infection, and arterial injuries [6].…”

Section: Introductionmentioning

confidence: 99%

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Spahn

Wyatt

Stewart

et al. 2018

Clin Orthop Relat Res

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Background Surgical attempts at lower limb preservation after trauma may be complicated by pain and gait disturbances, which can impact the activity level of a military service member. It is unclear how later transtibial amputation (TTA) might affect patients who elect this option after attempts at limb preservation. Questions/purposes The purposes of the study were to compare preamputation and postamputation (1) the numeric rating scale for pain and pain medication use; (2) self-reported activity level, Four Square Step Test (FSST) results, and assistive device use; and (3) spatiotemporal variables measured with instrumented gait analysis in individuals who elected TTA after multiple attempts at limb preservation. Methods Retrospective review revealed 10 patients with unilateral lower extremity injuries who underwent late TTA between 2008 and 2016. All patients had undergone multiple limb preservation attempts and had completed instrumented gait evaluations as part of their routine care before and after TTA. One patient was excluded as a result of short followup. The remaining nine patients (eight men, 29 6 6 years) averaged five surgeries before amputation. Injuries were from improvised explosive devices (six), motorcycle accidents (two), and one training accident. Strict indications for amputation were pain, difficulties performing activities of daily living, limited physical function, and medication dependence. Data for the aforementioned purposes were collected by gait laboratory staff before and 8 to 17 months after amputation. Time to TTA after initial injury was 5 6 3 years. At the start of the gait analysis study, pain was assessed at rest, activity level was recorded by patient report, and the FSST was administered. Results After TTA, there was a decrease in pain scores from 4 6 2 to 1 6 1 and patients using narcotics decreased

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Section: Introductionmentioning

confidence: 99%

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Spahn

Wyatt

Stewart

et al. 2018

Clin Orthop Relat Res

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“…Among those symptomatic patients, 88 percent met study criteria for significant levels of pain, sleep disturbance, depression, or anxiety; physical functioning and mental health functioning were roughly one and two standard deviations below population norms, respectively (Young-McCaughan et al, 2017). In a case series analysis of individuals injured during recent military conflicts who had undergone late amputation following limb salvage, poor mental health and dissatisfaction with limb reconstruction each were cited as reasons for undergoing late amputation in the majority of patients (Krueger et al, 2015).…”

Section: Epidemiological Researchmentioning

confidence: 99%

Limb Salvage and Recovery After Severe Blast Injury: Eighth Department of Defense International State-of-the-Science Meeting on Blast Injury Research

Engel¹,

Simmons²,

Heins³

et al. 2020

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“…Patients undergoing limb salvage secondary to a combat injury may not experience an improvement in their mental health after amputation. 18 Length of time using a prosthesis is negatively correlated with general psychiatric symptoms. In other words, the faster a patient is able to stand with a well-fitting prosthesis and maintain standing in that limb, the better their well-being could become.…”

Section: Physical Therapy Outcome Assessment Casementioning

confidence: 99%

A Unique Application of Negative Pressure Wound Therapy Used to Facilitate Patient Engagement in the Amputation Recovery Process

Wise

White

Stinner

et al. 2017

Advances in Wound Care

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Amputation rates during recent military conflicts were at an all-time high, but medical treatment of those amputations and attitudes of service members to get back to duty are also surging ahead. We present the cases of an active duty rescue C130 pilot with an above-the-knee amputation and a retired army sergeant with a below-the-knee amputation. Successful rehabilitation was augmented in both cases by using negative pressure incorporated in a custom prosthetic socket to accelerate incision closure, improve self-efficacy in wound care, and self-management, ultimately leading to faster recovery times, full engagement of the rehabilitation process, and return to active duty.

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Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Cited by 29 publications

References 43 publications

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Limb Salvage and Recovery After Severe Blast Injury: Eighth Department of Defense International State-of-the-Science Meeting on Blast Injury Research

A Unique Application of Negative Pressure Wound Therapy Used to Facilitate Patient Engagement in the Amputation Recovery Process

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