Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised...

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Wound Management

Background:

• Lower limb crush injuries frequently lead to amputation and are associated with significant mortality and morbidity.
• Surgical site infections (SSIs) are a common complication, increasing healthcare costs and delaying patient rehabilitation.
• Optimizing amputation stump closure is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the outcomes of early versus delayed primary closure of lower extremity amputation stumps following crush injury.
• To evaluate the rates of surgical site infections (SSIs), length of hospital stay, and the number of surgical interventions required in both closure groups.

Main Methods:

• A randomized controlled study involving 56 patients (63 amputation stumps) undergoing lower limb amputation below the hip joint.
• Patients were randomized into two groups: Group I (primary closure) and Group II (delayed primary closure).
• Outcomes assessed included SSI rates, mean hospital stay, and the number of additional surgeries.

Main Results:

• No statistically significant difference was observed in SSI rates between primary closure (23.3%) and delayed primary closure (27.3%) groups (P > .05).
• Mean hospital stay was comparable between the groups: 10.32 ± 7.68 days for primary closure and 11 ± 8.17 days for delayed primary closure (P > .05).
• The number of additional surgical interventions required did not differ significantly between the two groups.

Conclusions:

• Primary closure of lower extremity amputation stumps following trauma can be safely performed.
• Adequate wound lavage and debridement are essential when opting for primary closure to minimize complications.
• Early closure offers a safe and effective alternative to delayed closure, potentially streamlining patient management.