Post-traumatic lower-limb amputation: Indications, techniques and results

This study presents a review of traumatic lower-limb amputation, addressing 6 questions. (1) In what circumstances is amputation necessary in traumatology? (2) Are scores and results analyses contributive to decision-making for emergency amputation? Amputation can be primary, when directly caused by the trauma, salvage if limb conservation would be life-threatening, a necessity if functional prognosis is poor, or else necessitated by a mass-casualty context. Score systems and results analysis can help identify patients who would benefit from amputation or salvage, but applications are controversial, and the surgeon's expertise is a determining factor for treatment option in emergency settings. (3) What are the technical principles of amputation in traumatology? These principles must take account of the limitations imposed by emergency settings, in which the stump cannot always be optimized. In the acute phase, non-closure is the rule, and delayed stump shaping is preferable, to limit complications. (4) What quality of life can the amputee expect? Quality of life is a major issue in traumatic amputation. Prosthetics can restore walking capacity and promote social, occupational and familial autonomy. (5) How can complications be prevented and treated after traumatic amputation? Frequent complications include infection, cover defect, heterotopic ossification and chronic pain. These often require adaptation of the prosthesis or surgery by a specialized team. (6) Apart from surgery, what considerations guide management? Other aspects have to be integrated in the care pathway: regulatory considerations, shared decision-making, multidisciplinary teamwork, and psychological and social factors.