Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction.
OBJECTIVE
The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery.


METHODS
This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between July 2006 and December 2014, with an age range between 18 and 80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles.


RESULTS
Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53±10years were interviewed. Six patients had a SIP <5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8±11.5 for the physical component, and 57.4±7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers. Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement.


CONCLUSIONS
The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.
Department of Orthopaedics, University of Pretoria, Pretoria, South Africa; Walk-a-Mile Centre for Advanced Orthopaedics, Unitas Hospital & Mediclinic Midstream, Pretoria, South Africa.
Lana
L
van der Merwe
Department of Orthopaedics, University of Pretoria, Pretoria, South Africa; Walk-a-Mile Centre for Advanced Orthopaedics, Unitas Hospital & Mediclinic Midstream, Pretoria, South Africa.
Franz
F
Birkholtz
Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia; Orthopaedic Research Centre of Australia, Australia.
Kevin
K
Tetsworth
Walk-a-Mile Centre for Advanced Orthopaedics, Unitas Hospital & Mediclinic Midstream, Pretoria, South Africa; Medical School, University of Queensland, Australia; Orthopaedic Research Centre of Australia, Australia. Electronic address: ehohmann@optusnet.com.au.
Erik
E
Hohmann
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D023821:Limb Salvage / Q000523:psychology / Q000534:rehabilitation; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data*; D018434:Sickness Impact Profile; D016896:Treatment Outcome
Delayed amputation; Limb reconstruction; Limb salvage surgery; Lower limb trauma