Infectious Complications and Soft Tissue Injury Contribute to Late Amputation After Severe Lower Extremity Trauma
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background Although most combat-related amputations occur early for unsalvageable injuries, 15 occur late after reconstructive attempts. Predicting which patients will abandon limb salvage in favor of definitive amputation has not been explored. The purpose of this study was to identify factors contributing to late amputation for type III open tibia fractures sustained in combat. Methods Operative databases were reviewed to identify all combat-related type III open diaphyseal tibia fractures from March 2003 to September 2007. Patients were categorized based on their definitive treatment group I, limb salvage group II, early amputation 12 weeks postinjury group III, late amputation 12 weeks postinjury. Injury, treatment, and complication data were extracted from medical records and compared across groups. Results We identified 213 consecutive fractures, including 166 77.9 treated definitively with limb salvage, 36 16.9 with early amputation, and 11 5.2 with late amputation. There was no difference in fracture severity among the three groups. Before amputation, group III was more likely to use autograft and bone morphogenic protein 27.3, compared with group I 4.8 and group II 0, and was more likely to undergo rotational flap coverage 45.5, compared with group II 0. Group III patients had the highest average number of revision surgeries and rate of deep soft tissue infection and were more likely to have osteomyelitis 54.5 before amputation compared with group I 13.9 and group II 16.7. Conclusion Patients definitively managed with late amputation were more likely to have soft tissue injury requiring flap coverage and have their limb salvage course complicated by infection.
- Anatomy and Physiology
- Medicine and Medical Research