Limb Salvage Versus Traumatic Amputation A Decision Based on a Seven-part Predictive Index

Abstract

In severe traumatic injuries to the lower extremity, it is often a difficult decision to attempt heroic efforts aimed at limb salvage or to amputate primarily. To answer this question, the authors performed a 5-year review of 70 limbs in 67 patients. Patients were identified as presenting with major lower extremity trauma and an associated arterial injury. Nineteen (27%) of the 70 limbs were amputated. Limb salvage was not related to the presence or absence of shock and order of repair (orthopedic or vascular). No statistical difference was noted between the time of injury to operative repair in either the amputated or limb salvage group. Limb salvage was related to warm ischemia time and the quantitative degree of arterial, nerve, bone, muscle, skin, and venous injury. A limb salvage index (LSI) was formulated based on the degree of injury to these systems. All 51 patients with an LSI score of less than 6 had successful limb salvage (p less than 0.001). All 19 patients with an LSI score of 6 or greater had amputations (p less than 0.001). Although statistics cannot replace clinical judgment, this index can be a valuable objective tool in the evaluation of the patient with a severely traumatized extremity.

Robotic therapy for phantom limb pain in upper limb amputees

“…This participant was placed within the control group (VR only) and uses prosthesis. Interestingly the participant noted that it took some time for him to believe that it was himself (1)(2)(3)(4)(5)(6)(7) from baseline through to the 2 nd follow up session for participant RNOH2. RNOH2's proprioceptive drift error (Fig.5) does generally suggest a decrease (linear R 2 = 0.03253) despite an approx.…”

“…The decision as to whether to attempt limb salvage or an amputation is difficult but in either case there are subsequent problems with rehabilitation including phantom pain and limb non-use [1]. Phantom limb phenomenon affects a large percentage of amputees (50-80%) and results in feeling body parts that are no longer there [2].…”

Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

“…T he decision to amputate or perform limb salvage of a severely injured lower extremity remains a difficult dilemma for orthopaedic surgeons, and multiple scoring systems [1][2][3][4][5][6][7] have been developed to assist them in making this decision. These published guidelines contain different criteria that are objective or subjective, or both.…”

“…These published guidelines contain different criteria that are objective or subjective, or both. The five commonly used scoring systems are the Mangled Extremity Severity Score (MESS) 1,3 ; the Limb Salvage Index (LSI) 5 ; the Predictive Salvage Index (PSI) 2 ; the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA) 4 ; and the Hannover Fracture Scale-98 (HFS-98) 6,7 . Advances in orthopaedic, plastic, and vascular reconstruction have made it possible to treat many severely injured limbs with salvage procedures.…”

“…A MESS of ‡7 points predicted amputation with 100% accuracy. The LSI was proposed by Russell et al 5 in 1991. The seven components of the LSI include injury to an artery, deep vein, nerve, bone, skin, and muscle as well as warm ischemia time.…”