Conversion From Limb Salvage to Late Amputation: Lessons Learned From Recent Battlefields With Application to...

Area of Science:

• Orthopaedic Surgery
• Trauma Surgery
• Reconstructive Surgery

Background:

• High-energy trauma and battlefield injuries pose significant challenges for limb salvage.
• Despite surgical interventions, some patients opt for late amputation due to persistent complications.

Purpose of the Study:

• To review risk factors associated with late amputation following initial limb salvage procedures.
• To analyze patient and military-specific factors influencing the decision for late amputation.

Main Methods:

• Systematic literature review of English language, peer-reviewed articles published between 1993 and 2013.
• Inclusion of studies reporting data on late amputation rates after limb salvage in civilian and military populations.

Main Results:

• Late lower extremity amputation rates ranged from 3.9% to 40% in civilians and 5.2% to 15.2% in military patients.
• Key factors for late amputation include chronic pain, neurologic dysfunction, infection, poor limb function, and treatment burden.
• Military officers were 2.5 times more likely than enlisted personnel to elect late amputation.

Conclusions:

• Limb salvage efforts, while extensive, can yield disappointing outcomes necessitating late amputation.
• Understanding risk factors is crucial for managing patient expectations and optimizing treatment pathways after severe trauma.