ABSTRACT
This chapter considers amputation and replantation. Should the severely mangled limb be salvaged and should an already amputated limb be replanted?
Amputation
Traumatic amputation accounts for 11% of all amputations, and in the under 50s the figure approaches 50%. The decision to amputate is difficult. The limb must be considered both in the context of the patient’s acute condition and long-term health. Economic, social and psychological factors should be assessed, ideally involving the patient in the decision-making process. Independent orthopaedic and plastic surgical opinions on the feasibility of limb salvage are helpful. Prognostic factors include:
1. Local factors. The following are linked to a poor outcome:
• Vascular injury, especially if the warm ischaemia time exceeds 6 hours. • Gustilo IIIc injury, in which the amputation rate is 40-88%. • Infrapopliteal vascular injury of all three vessels-these have amputation rates around
100%. • Neurological injury-the restoration of protective sensation is critical to successful
outcome. • Soft tissue crush injury-as opposed to sharp cutting injury. • Loss of bone length in the lower limb. • Compartment syndrome. • Pre-existing limb disease-atherosclerosis.
