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Salami-Tactics: when is it time for a major cut after multiple minor amputations?
Martin C Berli1, Zoran Rancic2, Madlaina Schöni1
1Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland.
Archives of Orthopaedic and Trauma Surgery
|August 9, 2021
Summary
Repetitive minor amputations do not predict major amputation based on number alone. However, re-amputations within 90 days significantly increase the risk of major amputation, highlighting the importance of timing in limb salvage strategies.
Area of Science:
- Vascular Surgery
- Limb Salvage Surgery
- Reconstructive Surgery
Background:
- Repetitive minor amputations pose risks of multiple surgeries and major limb loss.
- Major amputations have significant physical and economic consequences.
Purpose of the Study:
- To determine if a specific number of minor amputations predicts a subsequent major amputation.
- To identify risk factors for major amputation following multiple minor amputations.
Main Methods:
- Retrospective chart review of 429 patients with 534 index minor amputations (1984-2019).
- Analysis of patient demographics and clinical data, including re-amputation number and level.
- Statistical analysis using stepwise multivariate Cox regression.
Main Results:
- 54.3% of legs underwent re-amputation; 16.7% ultimately required major amputation.
- No specific number of prior minor amputations predicted major amputation.
- Minor re-amputation within 90 days was the sole identified risk factor for major amputation (HR 3.8, p <0.001).
Conclusions:
- The number of prior minor amputations does not independently justify a major amputation.
- Timing of re-amputation is critical; within 90 days quadruples the risk of major amputation.
