Amputation Versus Limb Salvage

Amputation versus Limb Salvage

Reference: Tornetta Paul, Olson Steve, Instructional Course Lectures, 1997, Chapter 50

Main Message

It is difficult to calculate the different factors that contribute to limb salvage-ability in a meaningful way in order to predict who needs an amputation and who should have limb salvage.

Points of Interest

Consider amputation for severe IIIB and IIIC open injuries.
Factors that affect salvage include: vascular injury, degree of soft-tissue damage (influenced by the type of trauma – blunt vs penetrating), and others – age, injury score, comorbidities, other injuries

Scoring systems
Mangled extremity severity index – MESI
Mangled extremity severity score – MESS
Predictive salvage index – PSI
Limb salvage index – LSI
Nerve injury, ischemia, soft-tissue contamination, skeletal, shock, age – NISSA

Things that are considered in these scores:

ISS
Nature of skin injury
Vascular injury
Bony injury
Age
Pre-existing disease
Time to OR
Venous injury

None have been all that good at predicting outcome. The scoring systems are all affected by the subjective nature of the determination of the degree of soft-tissue injury, as well as the extent of ischemia and the severity of the venous injury.

Bonnani – Journal of Trauma, 1993: evaluated MESI, MESS, PSI, LSI and found that none were very successful in predicting the outcomes. Entitled “The Futility of Predictive Scoring of Mangled Lower Extremities”

Thoughts….

Just remember, they may be better off with amputation immediately.