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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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1
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.

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

PMID:
23245916
DOI:
10.1016/j.bjps.2012.11.026
[Indexed for MEDLINE]
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