Traumatic Amputation: The Effect of Early Guillotine on Surgical Site Infection

Traumatic amputations are morbid complications of blunt traumatic injury. Given the contaminated nature of these wounds, surgical site infections (SSIs) are frequent in this population. The natural history of these wounds following guillotine amputation is not well described. This study seeks to define the relation between operative technique, timing, and SSI.

Using our institutional trauma registry, we obtained data for all patients with an admitting ICD-10 code for an amputation. Those that underwent amputation for non-traumatic indications were excluded.

Between 2013 and 2023, 100 patients with traumatic extremity wounds presented to our Level 1 Trauma Center and subsequently underwent completion amputation. Most patients were males (70%), and the mean age was 42.7. Of the 100 patients, 65 underwent guillotine amputation, 39 of which occurred within six hours of arrival. Of the studied population, SSI developed in 24% of them. The patients in the SSI group compared with the non-SSI group had a mean hospital length of stay (LOS) of 30.2 days (vs. 16.5, p = 0.007). Patients who did not undergo an attempt at salvage had a mean mangled extremity score of 8.25 (vs. 6.14, p < 0.001), a mean injury severity score of 19.4 (vs. 14.5, p = 0.014), mean lactate at presentation of 5.37 (vs. 3.18, p = 0.004), and mean ICU LOS of 8.4 days (vs. 4.2, p = 0.021). Patients who underwent guillotine within six hours had a lower risk of SSI (12.8% vs. 31.1%, p = 0.036).

Understanding the impact of surgical timing and operative technique on SSI will inform surgeons about the best course of action when these difficult cases present to the trauma center. On the basis of these findings, early guillotine amputation in patients likely to undergo amputation was associated with a decrease in the rate of SSI.