Leech Caroline, Porter Keith
Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
Academic Department of Clinical Traumatology, University of Birmingham, Birmingham, UK.
Emerg Med J. 2016 Sep;33(9):641-4. doi: 10.1136/emermed-2015-204881. Epub 2016 Jun 8.
Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation.
A guillotine amputation of the distal femur was undertaken in fresh frozen self-donated cadavers. A prehospital doctor conducted a surgical amputation with Gigli saw or hacksaw for bone cuts and firefighters carried out the procedure using the reciprocating saw and Holmatro device. The primary outcome measures were time to full amputation and the number of attempts required. The secondary outcomes were observed quality of skin cut, soft tissue cut and CT assessment of the proximal bone. Observers also noted the potential risks to the rescuer or patient during the procedure.
All techniques completed amputation within 91 s. The reciprocating saw was the quickest technique (22 s) but there was significant blood spattering and continuation of the cut to the surface under the leg. The Holmatro device took less than a minute. The quality of the proximal femur was acceptable with all methods, but 5 cm more proximal soft tissue damage was made by the Holmatro device.
Emergency prehospital guillotine amputation of the distal femur can effectively be performed using scalpel and paramedic shears with bone cuts by the Gigli saw or fire service hacksaw. The reciprocating saw could be used to cut bone if no other equipment was available but carried some risks. The Holmatro cutting device is a viable option for a life-threatening entrapment where only firefighters can safely access the patient, but would not be a recommended primary technique for medical staff.
院前紧急截肢是一种罕见的手术，对于将处于时间紧迫情况下的被困患者解救出来可能是必要的。本研究旨在评估四种尸体下肢院前紧急截肢技术。
在新鲜冷冻的自愿捐献尸体上进行股骨远端的断头台式截肢。一名院前医生使用吉利锯或钢锯进行骨切割的手术截肢，消防员使用往复锯和霍尔马托设备进行该操作。主要观察指标为完全截肢所需时间和所需尝试次数。次要观察指标为观察到的皮肤切口、软组织切口质量以及近端骨的CT评估。观察者还记录了手术过程中对救援人员或患者的潜在风险。
所有技术均在91秒内完成截肢。往复锯是最快的技术（22秒），但有明显的血液飞溅，且切口延伸至腿部下方的表面。霍尔马托设备用时不到一分钟。所有方法对近端股骨的质量均可接受，但霍尔马托设备造成的近端软组织损伤多5厘米。
使用手术刀和护理人员剪刀，结合吉利锯或消防队钢锯进行骨切割，可有效地进行股骨远端的院前紧急断头台式截肢。如果没有其他设备，往复锯可用于切割骨头，但存在一些风险。对于只有消防员能够安全接近患者的危及生命的被困情况，霍尔马托切割设备是一个可行的选择，但对于医务人员来说，它不是推荐的主要技术。
