title: Conversion From Limb Salvage to Late Amputation: Lessons Learned From Recent Battlefields With Application to Civilian Trauma.
abstract: Battlefield injuries and high-energy civilian trauma present orthopaedic surgeons with treatment challenges. Despite efforts at limb salvage, some patients elect late amputation. This article reviews risk factors that predispose to late amputation. Using a MEDLINE search, English language peer-reviewed articles from 1993 to 2013 having data on late amputation following limb salvage were included. Late lower extremity amputation after limb salvage varied from 3.9% to 40% in civilian patients and from 5.2% to 15.2% in military patients. Factors influencing a patient's decision to undergo late amputation included a combination of complex pain symptoms with neurologic dysfunction, infection, a desire for improved limb functionality, and unwillingness to endure an often complicated and lengthy course of treatment. In military patients, rank was a significant risk factor since officers were 2.5 times more likely to elect late amputation (p < .05) than enlisted personnel. Despite often extraordinary efforts towardlimb salvage, results maybe disappointing.
authors.forename: D C
authors.initials: DC
authors.lastname: Covey
mesh_terms: D000671:Amputation, Surgical / Q000523:psychology / Q000706:statistics & numerical data*; D003657:Decision Making; D006801:Humans; D007869:Leg Injuries / Q000150:complications / Q000523:psychology / Q000601:surgery*; D023821:Limb Salvage / Q000523:psychology / Q000706:statistics & numerical data*; D008889:Military Personnel; D010146:Pain / Q000209:etiology / Q000523:psychology; D057240:Patient Preference; D012307:Risk Factors; D013997:Time Factors; D000067398:War-Related Injuries / Q000150:complications / Q000523:psychology / Q000601:surgery*