Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Abstract

Purpose:The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. Methods:This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between between July 2006 and December 2014, with an age range between 18-80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Results:Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53+10 years were interviewed. Six patients had a SIP < 5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8+11.5 for the physical component, and 57.4+7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers.Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. Conclusion:The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.

Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex

“…Complication rates with limb salvage and circular external fixation are characteristically high. 2 , 4 , 12 – 14 , 39 The overall complication rate in this series was 48% and is similar to the rate of complications reported previously. 2 , 4 , 12 – 14 , 39 The most common complication was superficial pin site infection, noted in 46% of patients in the TL-Hex group and 33% in the TSF group.…”

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

“…Limb salvage is often associated with a high rate of complications [18,22]. The overall complication rate in this series was 40%, similar to the rate of complications reported previously [9,14,15,31,32].…”

“…The diagnosis of deep infection is generally associated with considerable morbidity, and often requires multiple procedures and a protracted course of treatment [16,17]. Although successful limb salvage can be achieved in approximately 80% of cases, amputation is not uncommon [16][17][18]. Given these uncertain outcomes it was therefore the purpose of this study to evaluate functional outcomes following failed plate fixation in distal tibia fractures salvaged with hexapod circular fixators.…”

Patient-reported Outcome Measures following Traumatic Lower Extremity Amputation: A Systematic Review and Meta-analysis

“…26 , 27 , 40 QOL was also reported by studies in the SIP and EuroQol Questionnaire (EQ-5D). 10 , 41 – 45 …”

“… 6 Further, the PCO research that does exist lacks cohesiveness and standardization, with few measures specific to lower extremity trauma and amputation. 7 , 8 Validated patient-reported outcome measures (PROMs) that assess multiple aspects of treatment outcomes, such as the Short Form Survey-36 and the Sickness Impact Profile (SIP), are frequently used in this patient population 9 , 10 ; however, QOL PROM scales specific to patients after traumatic MLEA are rare, prohibiting assessment of the success of treatment options to meet specific needs, values, and expectations of the traumatic amputation patient. 11 …”