title: Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients.
abstract: BACKGROUND
  Following severe lower extremity trauma, patients who undergo limb reconstruction and amputations both endure frequent complications and mental health sequelae. The purpose of this study is to assess the extent to which late amputation following a period of limb salvage impacts the evolution of the clinical variables that can affect the patient's perception of his or her limb: ongoing limb associated complications and mental health conditions.
  
  
  METHODS
  A case series of US service members who sustained a late major extremity amputation from September 2001 through July 2011 were analysed. Pre- and post-amputation complications, mental health conditions, and reason(s) for desiring amputation were recorded.
  
  
  RESULTS
  Forty-four amputees with detailed demographic, injury and treatment data were identified. The most common reasons for desiring a late amputation were pain and being dissatisfied with the function of the salvage limb. An average of 3.2 (range 1-10) complications were reported per amputee prior to undergoing late amputation and an average of 1.8 (range 0-5) complications reported afterwards. The most common complication prior to and after late amputation was soft tissue infection (24 (17%) and 9 (22%), respectively). Twenty-nine (64%) late amputees were diagnosed with a mental health condition prior to undergoing their amputation and 27 (61%) late amputees were diagnosed with mental conditions after late amputation. Only three of the 15 patients who did not have a mental health condition documented prior to their late amputation remained free of a documented mental health condition after the amputation.
  
  
  CONCLUSIONS
  Ongoing complications and mental health conditions can affect how a patient perceives and copes with his or her limb following severe trauma. Patient dissatisfaction following limb reconstruction can influence the decision to undergo a late amputation. Patients with a severe, combat related lower extremity injury that are undergoing limb salvage may not have a reduction in their overall complication rate, a resolution of specific complications or an improvement of their mental health after undergoing late amputation.
  
  
  CONCLUSIONS
  Surgeons caring for limb salvage patients should counsel appropriately when managing expectations for a patient who desires a late amputation.
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX, United States. Electronic address: cak0705@gmail.com.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Rivera
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: Tennent
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sheean
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Stinner
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000523:psychology; D001134:Arm Injuries / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D001753:Blast Injuries / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D003863:Depression / Q000453:epidemiology*; D037001:Directive Counseling; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic; D014481:United States; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*
keywords: Combat injury; Late amputation; Limb reconstruction; Limb salvage; PTSD