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J Plast Reconstr Aesthet Surg. 2013 Apr;66(4):531-7. doi: 10.1016/j.bjps.2012.11.026. Epub 2012 Dec 12.

Delayed amputation following trauma increases residual lower limb infection.

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Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kennedy Institute of Rheumatology, University of Oxford, ARC Building, 65 Aspenlea Road, Hammersmith, London W6 8LH, UK.



Residual limb infection following amputation is a devastating complication, resulting in delayed rehabilitation, repeat surgery, prolonged hospitalisation and poor functional outcome. The aim of this study was to identify variables predicting residual limb infection following non-salvageable lower limb trauma.


All cases of non-salvageable lower limb trauma presenting to a specialist centre over 5 years were evaluated from a prospective database and clinical and management variables correlated with the development of deep infection.


Forty patients requiring 42 amputations were identified with a mean age of 49 years (±19.9, 1SD). Amputations were performed for 21 Gustilo IIIB injuries, 12 multi-planar degloving injuries, seven IIIC injuries and one open Schatzker 6 fracture. One limb was traumatically amputated at the scene and surgically revised. Amputation level was transtibial in 32, through-knee in one and transfemoral in nine. Median time from injury to amputation was 4 days (range 0-30 days). Amputation following only one debridement and within 5 days resulted in significantly fewer stump infections (p = 0.026 and p = 0.03, respectively, Fisher's exact test). The cumulative probability of infection-free residual limb closure declined steadily from day 5. Multivariate analyses revealed that neither the nature of the injury nor pre-injury patient morbidity independently influenced residual limb infection.


Avoiding residual limb infection is critically dependent on prompt amputation of non-salvageable limbs.

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