Delayed amputation following trauma increases residual lower limb infection.

Journal article

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.

Authors: Jain, A; Glass, G; Ahmadi, H; Mackey, S; Simmons, J

• Publication status: Published
• Journal: Journal of plastic, reconstructive and aesthetic surgery : JPRAS
• Volume: 66
• Issue: 4
• Pages: 531-537
• Publication date: 2013-04-01
• DOI: 10.1016/j.bjps.2012.11.026
• EISSN: 1878-0539
• ISSN: 1748-6815
• Language: English
• Keywords: Time Factors; Adult; Aged, 80 and over; Male; Adolescent; Amputation Stumps; Humans; Amputation; Aged; Surgical Wound Infection; Female; Lower Extremity; Multivariate Analysis; Wounds and Injuries; Middle Aged; Debridement; Young Adult