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Related Experiment Videos

The mangled extremity. When to amputate?

M S Roessler1, D H Wisner, J W Holcroft

  • 1Department of Surgery, University of California, Davis Medical Center, Sacramento.

Archives of Surgery (Chicago, Ill. : 1960)
|October 1, 1991
PubMed
Summary
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Immediate amputation of mangled lower extremities is critical when no distal pulse is present, guiding limb salvage decisions. Systemic compromise, indicated by fluid balance, may necessitate amputation within 24 hours.

Area of Science:

  • Trauma Surgery
  • Orthopedic Surgery
  • Vascular Surgery

Background:

  • Mangled lower extremity injuries present complex management challenges.
  • Decisions regarding limb salvage versus amputation require careful consideration of multiple factors.

Purpose of the Study:

  • To identify key indications for immediate or delayed amputation in mangled lower extremities.
  • To evaluate the impact of various clinical parameters on limb salvage outcomes.

Main Methods:

  • Retrospective review of 80 patients with mangled lower extremities.
  • Analysis of vascular, neurologic, bone, and soft-tissue status.
  • Assessment of postoperative complications, mechanical ventilation, fluid balance, and survival rates.

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Main Results:

  • Neurologic, bone, and soft-tissue status influenced immediate amputation decisions but not delayed outcomes.
  • Presence of a distal pulse was critical for limb salvage.
  • Positive fluid balance (>3 L in 24 hours) in salvage attempts correlated with high amputation rates (5/6 patients).

Conclusions:

  • Limb salvage should be attempted if a distal pulse is present.
  • If no distal pulse is detected, immediate amputation decisions should be based on functional prognosis.
  • Amputation at 24 hours is indicated in salvage attempts if systemic compromise is evident, particularly with significant positive fluid balance.