Acquired limb loss in patients with traumatic brain injury.
The outcome associated with long-term prosthetic use was evaluated in 12 patients who had a dual disability of severe traumatic brain injury and an extremity amputation. The incidence and nature of complications after limb loss was also reviewed. The 12 patients sustained 15 extremity amputations. Lower extremity amputations were the most common disability. Fifty percent of the patients had at least one postoperative complication after amputation. All patients (100%) had at least one complication documented on rehabilitation admission. No patient was using a prosthesis at the time of rehabilitation admission. At discharge six patients were able to use a prosthesis. Only one patient was considered independent. Patient follow-up averaged 28.6 months. At long-term follow-up six patients were using a prosthesis. Four were considered independent. One-third of the total group was considered able to use the prosthesis independently in the community. Of the lower extremity amputated population, only 40% became ambulatory. This is considerably less than can be expected to become ambulatory if there was no amputation. All three upper extremity amputees did not use a prosthesis. All efforts should be directed at salvaging a limb threatened by amputation after survival of traumatic brain injury. Early transfer to a facility specializing in traumatic brain injury rehabilitation may decrease complications, reduce total hospitalization and improve overall functional ability.
Stone
L R
LR
Adult Brain Injury Service, Rancho Los Amigos Medical Center, Downey, CA 90242.
Keenan
M A
MA
Shin
D Y
DY
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001132:Arm; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000534:rehabilitation*; D019736:Prostheses and Implants / Q000534:rehabilitation*; D012047:Rehabilitation Centers; D013530:Surgical Wound Infection