title: Early delayed amputation: a paradigm shift in the limb-salvage time line for patients with major upper-limb injury.
abstract: Patients with major injuries to the upper limbs sometimes fail to achieve successful limb salvage. During the attempt to fashion a functional limb, multiple painful procedures may be ventured. Despite the best efforts of surgeons and therapists, a nonfunctioning or painful upper limb may remain in place for many months or years before late delayed amputation and progression to productive rehabilitation occur. We present three patient cases that illustrate failed upper-limb salvage. In each case, patients expressed a desire for amputation at 6 months after their injury. To reduce the pain and suffering that patients with failed limb salvage endure, we propose a paradigm shift in the limb-salvage time line. We suggest that patients be evaluated for early delayed amputation 6 months after their injury.
authors.affiliation: Department of Surgery, Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Todd.E.Burdette@Hitchcock.ORG
authors.forename: Todd E
authors.initials: TE
authors.lastname: Burdette
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Long
authors.forename: Oscar
authors.initials: O
authors.lastname: Ho
authors.forename: Chris
authors.initials: C
authors.lastname: Demas
authors.forename: John-Erik
authors.initials: JE
authors.lastname: Bell
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods*; D001134:Arm Injuries / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000592:standards*; D008297:Male; D008875:Middle Aged; D013997:Time Factors