Reoperation and complication rates in acute lower limb amputations due to trauma

Lower limb amputation is associated with significant morbidity and mortality. Reflecting the predominance of vascular or diabetic disease as a cause for lower limb amputation, much of the available literature excludes lower limb amputation secondary to trauma in the reporting of complication rates. This paucity of literature represents a research gap in describing the incidence of complications in lower limb amputations due to trauma, which we aim to address.

A retrospective analysis was undertaken of a prospectively collected database of lower limb amputations secondary to trauma from a regional multidisciplinary amputee service in London. Clinical records were consulted for evidence of reoperation, infection, phantom limb pain, neuroma, and contralateral limb arthritis. A multivariable regression model was created to establish risk factors for reoperation. A total of 213 amputations (200 patients) were included in the final analysis.

Mean age at amputation was 33 years (1 to 90), with a mean follow-up of 230 months (2 to 734). Overall, 35.2% of patients (n = 75) underwent reoperation, and 27.7% (n = 59) had at least one episode of infection. Of those who underwent reoperation, 44% (n = 33) had evidence of infection. Phantom limb pain and neuroma were reported in 39.9% (n = 85) and 10.8% (n = 23), respectively. Contralateral limb osteoarthritis was documented in 7%. Presence of infection is a statistically significant risk factor, conferring a 3.9 times increased risk of reoperation.

Lower limb amputations secondary to trauma exhibit higher rates of reoperation and infection compared to vascular or diabetic amputees. This is the first and largest study to provide high-quality data describing the incidence of complications in patients with lower limb amputations due to trauma in the UK.