Traumatic and trauma-related amputations: part I: general principles and lower-extremity amputations.
Deliberate attention to the management of soft tissue is imperative when performing an amputation. Identification and proper management of the nerves accompanied by the performance of a stable myodesis and ensuring robust soft-tissue coverage are measures that will improve patient outcomes. Limb length should be preserved when practicable; however, length preservation at the expense of creating a nonhealing or painful residual limb with poor soft-tissue coverage is contraindicated. While a large proportion of individuals with a trauma-related amputation remain severely disabled, a chronically painful residual limb is not inevitable and late revision amputations to improve soft-tissue coverage, stabilize the soft tissues (revision myodesis), or remove symptomatic neuromas can dramatically improve patient outcomes. Psychosocial issues may dramatically affect the outcomes after trauma-related amputations. A multidisciplinary team should be consulted or created to address the multiple complex physical, mental, and psychosocial issues facing patients with a recent amputation.
Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307, USA.
Scott M
SM
Tintle
John J
JJ
Keeling
Scott B
SB
Shawen
Jonathan A
JA
Forsberg
Benjamin K
BK
Potter
D000671:Amputation, Surgical / Q000379:methods*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery*; D016896:Treatment Outcome