title: Reoperation after combat-related major lower extremity amputations.
abstract: OBJECTIVE
  Complication rates leading to reoperation after trauma-related amputations remain ill defined in the literature. We sought to identify and quantify the indications for reoperation in our combat-injured patients.
  
  
  METHODS
  Retrospective review of a consecutive series of patients.
  
  
  METHODS
  Tertiary Military Medical Center.
  
  
  METHODS
  Combat-wounded personnel sustaining 300 major lower extremity amputations from Operations Iraqi and Enduring Freedom from 2005 to 2009.
  
  
  METHODS
  We performed a retrospective analysis of injury and treatment-related data, complications, and revision of amputation data. Prerevision and postrevision outcome measures were identified for all patients.
  
  
  METHODS
  The primary outcome measure was the reoperation on an amputation after a previous definitive closure. Secondary outcome measures included ambulatory status, prosthesis use, medication use, and return to duty status.
  
  
  RESULTS
  At a mean follow-up of 23 months (interquartile range: 16-32), 156 limbs required reoperation leading to a 53% overall reoperation rate. Ninety-one limbs had 1 indication for reoperation, whereas 65 limbs had more than 1 indication for reoperation. There were a total of 261 distinct indications for reoperation leading to a total of 465 additional surgical procedures. Repeat surgery was performed semiurgently for postoperative wound infection (27%) and sterile wound dehiscence/wound breakdown (4%). Revision amputation surgery was also performed electively for persistently symptomatic residual limbs due to the following indications: symptomatic heterotopic ossification (24%), neuromas (11%), scar revision (8%), and myodesis failure (6%). Transtibial amputations were more likely than transfemoral amputations to be revised due to symptomatic neuromata (P = 0.004; odds ratio [OR] = 3.7; 95% confidence interval [95% CI] = 1.45-9.22). Knee disarticulations were less likely to require reoperation when compared with all other amputation levels (P = 0.0002; OR = 7.6; 95% CI = 2.2-21.4).
  
  
  CONCLUSIONS
  In our patient population, reoperation to address urgent surgical complications was consistent with previous reports on trauma-related amputations. Additionally, persistently symptomatic residual limbs were common and reoperation to address the pathology was associated with an improvement in ambulatory status and led to a decreased dependence on pain medications.
authors.affiliation: *Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; †Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD; and ‡Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Tintle
authors.forename: Scott B
authors.initials: SB
authors.lastname: Shawen
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Donald A
authors.initials: DA
authors.lastname: Gajewski
authors.forename: John J
authors.initials: JJ
authors.lastname: Keeling
authors.forename: Romney C
authors.initials: RC
authors.lastname: Andersen
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects*; D006801:Humans; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000150:complications / Q000601:surgery*; D035002:Lower Extremity / Q000293:injuries / Q000601:surgery*; D008889:Military Personnel / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult