Limb Salvage Versus Amputation: A Review of the Current Evidence

Abstract

In the trauma situation where the trauma team is faced with a severely injured limb, it requires judicious thinking and evaluating not only the injury in isolation but the patient as a whole when considering the management options. The aim must be to give the best quality of life and avoid repeated admissions to hospital for associated complications in the future. The decision to amputate or salvage a limb should be based on numerous factors, such as the patient's pre-injury status, injury factors (soft tissue injury, location, contamination and physiological status), patient's wish and available resources. The biggest challenge when faced with a complex limb injury is deciding what management route to take with a satisfactory outcome for the patient being the main goal. Many studies have been undertaken looking at the outcome of successful limb salvage versus primary amputation. Studies such as the Learning Early About Peanut Allergy (LEAP) study have concluded that there was no difference of outcome at the two-year stage between the two strategies.

Long-term outcomes of lower limb post-traumatic osteomyelitis

“…Recurrence rates in case series vary from 0 to 24%. [ 39 – 42 ]. In our series the recurrence rate was 10%, where local antibiotics were used, we now use these agents as standard in keeping with the majority of current treatment algorithms [ 38 ].…”

The effect of time to amputation on medical costs accrued during the first twelve months after injury—A California workers’ compensation claims study

“…Workers in the study population tended to be male (89.2%), not have documented prosthetic care (92.9%), not have legal action associated with their claim (81.3%), and lower income (median annual salary 5 $32,895). The median (interquartile range (IQR)) number of medical visits in the first month and number of unique diagnoses and procedures was 11 (7)(8)(9)(10)(11)(12)(13)(14)(15) and 27 , respectively. The median (IQR) medical dollars paid per claim during the first 12 months was $12,414 ($6,324-$29,347).…”

“…There are clinical indicators, such as the vascular status of the injured person, the presence and extent of nerve damage, and risk of infection, that can guide treating medical personnel toward either limb salvage or amputation. 7,11 In general, the consensus is to salvage the injured limb and if an amputation is unavoidable, to maintain as much of the residual limb as possible. 11,12 However, the early decision to either salvage the damaged limb or perform an amputation has long-term functional, psychological, and financial consequences, whose full extent are still not clear.…”

“…6 Outcomes after an amputation may be influenced by the initial injury, the subsequent medical care, and finally the level of physical and mental well-being that can be established during the physical and vocational rehabilitation process. 2,4,7,8 When dealing with an injury that may or may not result in an amputation, the decision-making process after injury is complex, and there is still no definitive protocol as to what is the most advisable course of action. [7][8][9][10] The very first priority is to preserve life, 7 but there are many decisions during the initial treatment phase that will have a significant long-term impact on the injured worker.…”

“…2,4,7,8 When dealing with an injury that may or may not result in an amputation, the decision-making process after injury is complex, and there is still no definitive protocol as to what is the most advisable course of action. [7][8][9][10] The very first priority is to preserve life, 7 but there are many decisions during the initial treatment phase that will have a significant long-term impact on the injured worker. One of the most significant decisions is whether to pursue limb salvage as opposed to performing an amputation after an injury.…”