Yowler C J, Mozingo D W, Ryan J B, Pruitt B A
United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA.
J Trauma. 1998 Sep;45(3):522-6. doi: 10.1097/00005373-199809000-00017.
Previous series of traumatic amputations have noted that delay in amputation results in prolonged hospital stay and delayed rehabilitation. A series of major extremity amputations after burn injury was analyzed to identify the frequency of delayed amputation and to identify factors resulting in the delay.
Chart review of burn admissions between January of 1991 and December of 1995.
Twenty-eight patients underwent a total of 44 major extremity amputations. Thirty-five amputations in 22 patients were performed by postburn day 16 (mean 4.3). Nine amputations in six patients were delayed beyond postburn day 26 (mean, 48.3). Delayed amputations occurred in the subgroups of deep thermal burns with extensive necrosis and thermal burns complicated by infections. Early amputation was associated with a 13.6% mortality rate, delayed amputation with a 50% mortality rate.
There is a bimodal distribution of time to amputation determined by mechanism of injury, severity of burn, and infectious complications. Earlier identification of nonsalvageable limbs may decrease infectious complications and improve the chances of patient survival.
以往关于创伤性截肢的系列研究指出，截肢延迟会导致住院时间延长和康复延迟。对一系列烧伤后大肢体截肢病例进行分析，以确定延迟截肢的发生率，并找出导致延迟的因素。
回顾1991年1月至1995年12月期间烧伤患者的病历。
28例患者共接受了44次大肢体截肢手术。22例患者中的35次截肢在烧伤后第16天之前进行（平均4.3天）。6例患者中的9次截肢延迟至烧伤后第26天以后（平均48.3天）。延迟截肢发生在深度热烧伤伴广泛坏死以及热烧伤合并感染的亚组中。早期截肢的死亡率为13.6%，延迟截肢的死亡率为50%。
截肢时间呈双峰分布，这取决于损伤机制、烧伤严重程度和感染并发症。更早识别无法挽救的肢体可能会减少感染并发症并提高患者存活几率。
