The Medical and Economic Impact of Severely Injured Lower Extremities

Bondurant, Fonda J.; Cotler, Howard B.; Buckle, Rosemary; Miller-Crotchett, Priseilla; Browner, Bruce D.

doi:10.1097/00005373-198707000-00031

Cited by 23 publications

(36 citation statements)

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“…It is important to subscribe early in such a program within the first year after trauma. Waiting means useless [21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Rapid rehabilitation and return to a functional life are usually possible [21][22][23][24][25][26][27]. Social reintegration in primary amputation is usually achieved after 4-6 months.…”

Section: Discussionmentioning

confidence: 99%

“…This avoids protracted hospital courses, multiple surgeries, multiple subsequent hospitalizations, complications (especially infection and nonunion) and the often inevitable delayed amputation of a viable but not functional lower leg. As a result of this protracted experience, many patients are physically, psychologically, socially and financially ruined [22,23,25,28]. Studies have also shown that the chances of rapid rehabilitation and recovery from injury are poorer for patients with multiple procedures and prolonged hospitalization than for those with primary amputation [25,28].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Results after Lower-Leg Replantation

et al. 2005

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European Journal of Trauma Ab stractBackground: Although subtotal and total lower-leg amputation have been sucessfully replanted in the past, nowadays there is a common opinion that "these replantations do not justify their efforts, and therefore the patients should undergo primary amputation". Patients and Methods: In order to clarify this hypothesis, a retrospective clinical study of own cases operated on between 1981 -1998 and an extensive literature research we carried out. The following criteria were evaluated: (1) survival rate, (2) individual motor and sensory functions and global lower extremity function judged according to the classification of Chen et al., (3) socioeconomic aspects (operation time, number of operations per patient, time of hospitalization, return to normal life), (4) number and nature of local and/or systemic complications, and (5) subjective judgment by the patient. Results: All replanted lower legs in this series survied.Using the classification of Chen et al. the functional results can be given as follows: stage I 64.2%, stage II 28.5% (thus, a "functional extremity" could be reconstructed in 92.7%), stage III 7.1%, and stage IV 0%. Social reintegration was achieved within 8-10 months after replantation. Four to seven secondary operations were carried out in every patient in order to improve the result. Total duration of therapy was 28-48 months. There were no secondary reamputation. Conclusion: Using an algorithm developed by the authors, there is a significant decrease in replantation frequency on the one hand (30% of all tranferred cases in the own replantation center). However, on the other hand those cases replanted show better functional and aesthetic results and a significantly lower replantation risk. The results of this study as well as those of other large series show that lower-leg replantation is still worthwhile in a well-selected patient group, contrary to what is believed by an increasing number of orthopedic and trauma surgerons.

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“…It is important to subscribe early in such a program within the first year after trauma. Waiting means useless [21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Rapid rehabilitation and return to a functional life are usually possible [21][22][23][24][25][26][27]. Social reintegration in primary amputation is usually achieved after 4-6 months.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Results after Lower-Leg Replantation

et al. 2005

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“…Numerous reports have documented the differences in number and complexity of operations performed, in duration of hospitalization, and in number and type of complications in patients with successfully attempted limb salvage on the one hand and those undergoing primary or secondary amputations on the other [2,5,6,43,[47][48][49].…”

Section: Short-termmentioning

confidence: 99%

“…The patients in whom salvage is attempted undergo more major reconstructive procedures (e.g., fracture fixation, free and [micro]vascular tissue transplantations, and/or vascular reconstructions) [6]. In their comparison of the consequences of primary versus secondary amputation, Bondurant et al [47] showed that a delay in amputation was associated with an even more dramatic increase in the number of operations (1.6 for primary and 6.9 for delayed amputations).…”

Section: Short-termmentioning

confidence: 99%

The Mangled Leg

Hoogendoorn¹,

Werken

2002

European Journal of Trauma

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A review of decision-making in the treatment of severe lower leg injuries is presented. In this article, several factors will be discussed which play a decisive role in the choice between an attempt at salvage and primary amputation. Based on these variables, predictive scoring systems have been proposed to objectify the regional injury severity of the limb in order to assist the surgeon in decision-making. The most widely described of these systems are compared. Furthermore, the short-and long-term consequences of treatment are discussed. Finally, a strategy for the treatment of mangled legs is proposed.

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