Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up

Tunalı, Onur; Sağlam, Yavuz; Balcı, Halil İbrahim; Kochai, Alauddin; Şahbaz, Nuri Alper; Sayın, Ömer Ali; Yazıcıoğlu, Önder

doi:10.1007/s00068-016-0689-y

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…However, according to several reports, limb salvage is more desirable than amputation in terms of psychological and long-term functional prognoses. By contrast, other reports have suggested that the time required by patients to return to work and hospitalization period are similar between the two interventions [1][2][3][9][10][11]. A meta-analysis showed that limb salvage and amputation are functionally equivalent, but limb salvage is the more psychologically acceptable approach [9]; this is consistent with another study that claimed amputation is more di cult to accept psychologically than salvage [3].…”

Section: Discussionsupporting

confidence: 61%

“…A meta-analysis showed that limb salvage and amputation are functionally equivalent, but limb salvage is the more psychologically acceptable approach [9]; this is consistent with another study that claimed amputation is more di cult to accept psychologically than salvage [3]. Most patients with salvaged limbs face problems in their daily lives owing to a limited range of motion, but none want amputation as an intervention [11]. A previous study showed no signi cant difference in the functional outcomes between the limb salvage and amputation groups for at least 7 years [1].…”

Section: Discussionmentioning

confidence: 55%

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Comparison of Patient-reported Outcomes at 1 Year after Injury between Limb Salvage and Amputation: A Prospective Cohort Study

Kurozumi

Inui

Nakayama

et al. 2021

Preprint

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Background: Owing to advances in knowledge and technology, salvaging the limbs of patients with severe trauma and injuries is possible. However, severe limb injuries occasionally necessitate amputation because it allows patients to regain their social lives earlier than limb salvaging. Moreover, previous related investigations are retrospective cohort studies or meta-analyses of retrospective studies, and prospective cohort studies of patient-reported outcomes are extremely rare. This single-center, prospective cohort study aimed to compare the patient-reported outcomes at 1 year after injury between limb salvage and amputation and to elucidate whether amputation contributes to early recovery of functionality and quality of life.Methods: We included 47 limbs of 45 patients with severe open fractures of the lower limb and categorized them into limb salvage and amputation groups. They were registered in the Database of Orthopedic Trauma by the Japanese Society for Fracture Repair at our center; data on patient-reported outcomes at 1 year after injury were obtained from this database. The mean patient age was 49.6 years. Patients’ limbs were evaluated using the lower extremity functional scale (LEFS) and Short-Form 8 (SF-8). Early recovery was evaluated using functionality and quality-of-life questionnaires. Nonparametric statistical analyses were conducted.Results: Of the 47 limbs, 34 limbs of 34 patients were salvaged and 13 limbs of 11 patients were amputated. Significant differences were noted between the limb salvage and amputation groups in terms of the LEFS scores (mean: 49.5 vs 33.1, P=0.025) and scores for the mental health component (mean: 48.7 vs 38.7, P=0.003), role–physical component (mean: 42.2 vs 33.3, P=0.026), and mental component summary (mean: 48.2 vs 41.3, P=0.042) of the SF-8. The limb salvage group had better scores than the amputation group. Conclusions: In this study, limb salvage results in better functional and mental health outcomes at 1 year after severe lower limb injury than after amputation. As reconstruction technology has advanced and limb salvaging has become possible, the focus of studies should now be based on the perspective of “how the patient feels”; hence, we believe that the results of this study, which is based on patient-reported outcomes, are meaningful.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 55%

Comparison of Patient-reported Outcomes at 1 Year after Injury between Limb Salvage and Amputation: A Prospective Cohort Study

Kurozumi

Inui

Nakayama

et al. 2021

Preprint

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“…[ 3 ] Attempted limb salvage has a higher risk for a longer hospital stay, more expense, a greater number of surgeries, and significantly higher rates of complications. [ 1 – 3 , 7 ] However, some patients may undergo secondary amputation because of failure in limb salvage. The reported rate of amputation is as high as 78%, [ 8 ] and the secondary amputation rate reaches 15% in grade IIIC fractures of the lower limb.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Predicting which patients should forego limb salvage and undergo amputation is a challenge to surgeons. Many investigators have reported on various amputation predictors for patients with grade IIIA or grade IIIB fractures of the lower limb, [ 1 , 2 , 9 , 10 ] but there are comparatively few studies on grade IIIC fractures of the lower limb. The aim of this study was to gather cases in our hospital and analyze the amputation predictors for patients with severe lower limb injuries.…”

Section: Discussionmentioning

confidence: 99%

“…With the expansion of vehicular traffic, the morbidity of severe lower limb injury caused by high-energy collisions is rising. [ 1 , 2 ] These patients often have extensive soft tissue damage and vascular injuries, with serious complications and sequelae. [ 3 , 4 ] Even for experienced surgeons, these injuries are challenging to treat.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of secondary amputation in patients with grade IIIC lower limb injuries

Song

Zhou²,

Dong³

2017

Medicine

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The aim of this study was to identify risk factors for failure of limb salvage surgery in grade IIIC lower extremity injuries.A single-institution, retrospective review was performed of all patients with grade IIIC lower limb injuries presenting from January 2009 to April 2014. We gathered the data on each patient who underwent limb salvage and analyzed the final outcome for these patients (limb salvage vs secondary amputation).Grade IIIC lower limb injuries were identified in 41 patients. Primary amputation was performed in 6 patients (15%) as the initial procedure. Thirty-five patients (85%) underwent vascular reconstruction and other surgical procedures to salvage the limb. Limb salvage was successful in 23 patients (66%); 12 patients (34%) ultimately underwent secondary amputation. The median time from injury to secondary amputation was 22.5 days (range 4–380 days). The mean Mangled Extremity Severity Score (MESS) was 7.2 ± 1.5 (range 5–10). The MESS was significantly higher in the secondary amputation group compared with the limb salvage group. Additionally, statistical testing revealed that the limb ischemia time, complex fractures, rate of fasciotomy, and number of vascular reconstruction were significantly higher in the secondary amputation group. Muscle necrosis and extensive soft tissue defect were the main reasons for secondary amputation.The findings indicate that MESS of 7 or greater, complex fractures, limb ischemia time equal to or greater than 6 hours, and osteofascial compartment syndrome were associated with an increased risk of delayed amputation. The MESS is highly prognostic but not perfect; decision-making in patients with an MESS of 7 or greater should be re-evaluated for clinical use.

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Difficult Decisions in Surgery: An Evidence-Based Approach Limb Salvage for the Mangled Extremity

Neuhaus¹,

Pape²

2021

Difficult Decisions in Trauma Surgery

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A mangled extremity is a combination of injuries to the bones, soft tissue, muscles, tendons, vessels, and/or nerves after high-energy trauma. It is an infrequent but severe injury. The difficult decision with mangled extremities is whether to amputate or to salvage the limb. There is no metric that can clearly predict the ideal patient for amputation or for salvage. Despite abundant literature, neither option (salvage vs. amputation) seems superior, and the best treatment remains controversialthe mangled extremity is a persistent problem with a poor outcome. A case-by-case decision-making process is still mandatory and warrants a multidisciplinary team approach.

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Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up

Abstract: Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.

Cited by 14 publications

References 27 publications

Comparison of Patient-reported Outcomes at 1 Year after Injury between Limb Salvage and Amputation: A Prospective Cohort Study

Comparison of Patient-reported Outcomes at 1 Year after Injury between Limb Salvage and Amputation: A Prospective Cohort Study

Predictors of secondary amputation in patients with grade IIIC lower limb injuries

Difficult Decisions in Surgery: An Evidence-Based Approach Limb Salvage for the Mangled Extremity

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