Beeharry Mohammad Waseem, Walden-Smith Thomas, Moqeem Komal
Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR.
Orthopaedics and Trauma, King's College Hospital NHS Foundation Trust, London, GBR.
Cureus. 2022 Oct 28;14(10):e30817. doi: 10.7759/cureus.30817. eCollection 2022 Oct.
In the setting of acute severe limb injury, the clinical decision to either attempt limb salvage or to perform a primary amputation presents a significant challenge to the trauma team. The initial step in the management of a mangled limb is invariably resuscitation and stabilisation of the patient and an evaluation of the limb. However, the decision-making process on whether to amputate vs attempt limb salvage is dependent on a range of complex factors. This includes assessing the degree of injury to the components of the limb architecture, essential skeletal stability, soft tissues, vasculature, and neurological structures. Whether or not the patient would survive an attempt to limb salvage is of course not the only variable to be taken into account. The likely and expected outcomes of attempted salvage in each individual case must be considered and furthermore, what the acceptable side-effect profile including the risk of failure would be for each individual patient should be assessed against the importance, real or perceived, that limb function is maintained. Finally, the patient's choice should also be taken into account alongside their occupation and pre-morbid functional status. How the surgeon makes this life-changing, or life-threatening decision, is of great clinical significance, and there are myriad scoring systems published that purport to assist in this matter. However, the changing structures of the trauma system, expansion and advancement of skillsets and technology means an updated review is required to help weigh up the challenging decision of limb amputation vs salvage, which usually takes place in a time-pressured and highly emotional emergency setting. An evidence-based, standardised structure to assist in these calculations could support surgeons and improve outcomes for these patients.
在急性严重肢体损伤的情况下，决定是尝试保肢还是进行一期截肢对创伤团队来说是一项重大挑战。处理严重毁损肢体的第一步总是对患者进行复苏和稳定病情，并对肢体进行评估。然而，决定截肢还是尝试保肢取决于一系列复杂因素。这包括评估肢体结构各组成部分的损伤程度、基本骨骼稳定性、软组织、血管系统和神经结构。患者能否在保肢尝试中存活当然不是唯一需要考虑的变量。必须考虑每个具体病例中保肢尝试可能的和预期的结果，此外，应根据维持肢体功能的实际或感知重要性，评估每个患者可接受的副作用情况，包括失败风险。最后，还应考虑患者的选择及其职业和病前功能状态。外科医生如何做出这个改变人生或危及生命的决定具有重大临床意义，并且已经发表了无数评分系统，旨在协助解决这个问题。然而，创伤系统结构的变化、技能和技术的扩展与进步意味着需要进行更新的综述，以帮助权衡截肢与保肢这一具有挑战性的决定，而这一决定通常是在时间紧迫且情绪高度紧张的紧急情况下做出的。一个基于证据的标准化结构来协助这些计算，可以支持外科医生并改善这些患者的治疗结果。
