OrthoCarolina, Foot and Ankle Institute, Charlotte, NC, USA.
J Orthop Trauma. 2013 Jan;27(1):43-8. doi: 10.1097/BOT.0b013e31825121b6.
To determine the outcome of the mangled foot and ankle undergoing limb salvage surgery that required free tissue flaps for wound closure compared with a similar patient foot and ankle injury group that underwent early below knee amputation (BKA).
: Prospective longitudinal study.
: Eight level 1 trauma centers.
PATIENTS/PARTICIPANTS: LEAP (Lower Extremity Assessment Project) study. One hundred seventy-four open severely injured hindfoot or ankle injuries (116 had salvage; 58 had a BKA).
Patients either required immediate amputation or salvage was attempted.
The Sickness Impact Profile (SIP) was the principal measure of outcome (higher SIP scores equal greater disability). Secondary outcomes included walking speed, number of rehospitalizations for injury-related complications, time to full weight-bearing, the visual analog pain scale, and return to work at 2 years.
When compared to patients treated with standard BKA, salvage patients who required free flaps and/or ankle arthrodesis had significantly worse 2-year outcomes. They had overall SIP scores that were 2.5 points higher and psychosocial SIP scores that were 8.4 points higher at 24 months (P = 0.014 and P = 0.013, respectively). Physical SIP scores were 3.7 points higher in the free flap and/or arthrodesis group but only approached statistical significance (P = 0.10). After adjusting for the need for free flap and/or arthrodesis, the salvage pathway had clinically, but not statistically, significantly better overall and psychosocial SIP scores than the standard BKA patients (P = 0.34 and P = 0.20, respectively).
: Patients with severe foot and ankle injuries who require free tissue transfer or ankle fusion have SIP outcomes that are significantly worse than BKA with typical skin flap design closure.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
比较接受游离组织皮瓣闭合创面的保肢手术与早期膝下截肢（BKA）治疗的类似足踝损伤患者的疗效，确定毁损性足踝损伤的结局。
前瞻性纵向研究。
8 个 1 级创伤中心。
患者/参与者：LEAP（下肢评估项目）研究。174 例开放性严重后足或踝关节损伤患者（116 例保肢；58 例行 BKA）。
患者需要立即截肢或尝试保肢。
Sickness Impact Profile（SIP）是主要的预后指标（SIP 评分越高，残疾程度越大）。次要结局指标包括行走速度、因伤再住院的次数、完全负重时间、视觉模拟疼痛评分和 2 年时的工作恢复情况。
与接受标准 BKA 治疗的患者相比，需要游离皮瓣和/或踝关节融合术的保肢患者 2 年预后明显较差。他们在 24 个月时的总体 SIP 评分高 2.5 分，心理社会 SIP 评分高 8.4 分（P = 0.014 和 P = 0.013）。游离皮瓣和/或融合组的生理 SIP 评分高 3.7 分，但仅接近统计学意义（P = 0.10）。在调整游离皮瓣和/或融合术的需求后，保肢组的总体和心理社会 SIP 评分明显优于标准 BKA 患者，但无统计学意义（P = 0.34 和 P = 0.20）。
需要游离组织移植或踝关节融合的严重足踝损伤患者的 SIP 结局明显差于采用典型皮瓣设计闭合的 BKA 患者。
治疗性 2 级。有关证据水平的完整描述，请参见作者说明。
