title: Delayed amputation following trauma increases residual lower limb infection.
abstract: BACKGROUND
  Residual limb infection following amputation is a devastating complication, resulting in delayed rehabilitation, repeat surgery, prolonged hospitalisation and poor functional outcome. The aim of this study was to identify variables predicting residual limb infection following non-salvageable lower limb trauma.
  
  
  METHODS
  All cases of non-salvageable lower limb trauma presenting to a specialist centre over 5 years were evaluated from a prospective database and clinical and management variables correlated with the development of deep infection.
  
  
  RESULTS
  Forty patients requiring 42 amputations were identified with a mean age of 49 years (±19.9, 1SD). Amputations were performed for 21 Gustilo IIIB injuries, 12 multi-planar degloving injuries, seven IIIC injuries and one open Schatzker 6 fracture. One limb was traumatically amputated at the scene and surgically revised. Amputation level was transtibial in 32, through-knee in one and transfemoral in nine. Median time from injury to amputation was 4 days (range 0-30 days). Amputation following only one debridement and within 5 days resulted in significantly fewer stump infections (p = 0.026 and p = 0.03, respectively, Fisher's exact test). The cumulative probability of infection-free residual limb closure declined steadily from day 5. Multivariate analyses revealed that neither the nature of the injury nor pre-injury patient morbidity independently influenced residual limb infection.
  
  
  CONCLUSIONS
  Avoiding residual limb infection is critically dependent on prompt amputation of non-salvageable limbs.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kennedy Institute of Rheumatology, University of Oxford, ARC Building, 65 Aspenlea Road, Hammersmith, London W6 8LH, UK.
authors.forename: Abhilash
authors.initials: A
authors.lastname: Jain
authors.forename: Graeme E
authors.initials: GE
authors.lastname: Glass
authors.forename: Hootan
authors.initials: H
authors.lastname: Ahmadi
authors.forename: Simon
authors.initials: S
authors.lastname: Mackey
authors.forename: Jon
authors.initials: J
authors.lastname: Simmons
authors.forename: Shehan
authors.initials: S
authors.lastname: Hettiaratchy
authors.forename: Michael
authors.initials: M
authors.lastname: Pearse
authors.forename: Jagdeep
authors.initials: J
authors.lastname: Nanchahal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000382:microbiology; D003646:Debridement; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000601:surgery; D055815:Young Adult