Amputation of a lower extremity after severe trauma.

OBJECTIVE

Serious lower extremity injuries sometimes warrant emergency amputation. The goal of amputation in polytrauma patients is to increase chances of survival, while the goal of amputation in a single limb injury is to prevent further complications, e.g., infection, septic shock.

INDICATIONS

Rescue from life-threatening lower extremity bleeding in a critically injured patient. Severe injury of a lower extremity: crushed, burned, frozen, advanced infection.

CONTRAINDICATIONS

Patient refusal.

SURGICAL TECHNIQUE

Supine position, determination of resection border, skin incision, identification of nerves and blood vessels, osteotomy, vessel ligation, separation of blood vessels and nerves, final removal of tissue with amputation knife, disposal of amputated extremity, skin closure.

POSTOPERATIVE MANAGEMENT

Wound care, careful compression wraps beginning on postoperative day 7, early prosthesis fitting, mental health care consultation.

RESULTS

From January 2008 until October 2010, 115 lower extremities were amputated at the BG Trauma Clinic in Ludwigshafen, Germany. A total of 42 amputations were posttraumatic and were performed in the clinic for trauma surgery and orthopedics. There were a total of 18 foot and toe amputations, 16 lower leg amputations, 5 knee amputations, and 3 above knee amputations. Comparison of the groups is difficult due to the varying mechanisms of injury and locations of amputation. Therapeutic decisions regarding emergency amputation are made with careful consideration of the patient.