Early versus delayed amputation in the setting of severe lower extremity trauma

• Published in: The American surgeon 2015-06, Vol.81 (6), p.564-568
• Main Authors: Williams, Zachary F, Bools, Lindsay M, Adams, Ashley, Clancy, Thomas V, Hope, William W
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amputation; Amputation - statistics & numerical data; Artificial Limbs - statistics & numerical data; Clinical outcomes; Female; Humans; Incidence; Infections; Injuries; Injury Severity Score; Intensive care; Intensive Care Units - statistics & numerical data; Leg; Leg Injuries - complications; Leg Injuries - epidemiology; Leg Injuries - pathology; Leg Injuries - surgery; Length of Stay; Limb Salvage; Lower Extremity - surgery; Male; Middle Aged; Prostheses; Quality of life; Retrospective Studies; Statistics, Nonparametric; Time Factors; Trauma centers; Treatment Failure; Young Adult
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481508100618

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.