title: Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury.
abstract: OBJECTIVE
  Severe lower limb trauma with arterial injury is often devastating for the individual. Many studies describe how to manage these injuries when they occur. Short-term functional outcome is quite well described, but the patients are often young, and their suffering is physical, mental, and social from a lifelong perspective. The aim of this study was to report patient experiences of their lives several years after their accidents, and to explore mechanisms of how to improve management.
  
  
  METHODS
  The Swedvasc registry was searched for participants from 1987 to 2011, living in the region of Uppsala, Sweden. Some amputated participants were added from the Walking Rehabilitation Center. There were five reconstructed patients with an intact limb, and three with amputations. In depth interviews were conducted and systematically analyzed, using A Giorgi's descriptive phenomenological method.
  
  
  RESULTS
  Eight patients participated, five with reconstructed and three with amputated limbs. Life affecting functional impairments were described by all patients. The patients undergoing amputation had received more structured follow up and support through the Walking Rehabilitation Center. The satisfaction with the cosmetic result was poorer than expected. All patients had developed strategies of how to cope with their impairments and stated they now lived "normal lives."
  
  
  CONCLUSIONS
  Despite substantial physical, psychological, and cosmetic impairments years after severe lower limb trauma, the participants described life as "normal" and mainly satisfactory. Transition to the new situation could have been facilitated by more frequent and continuous follow up after discharge from hospital, in particular among the non-amputated patients who tend to be lost to follow up. Findings also indicate that family members have to be acknowledged, strengthened, and supported.
authors.affiliation: Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: Karin.bernhoff@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Bernhoff
authors.affiliation: Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.affiliation: Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Larsson
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Jangland
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects / Q000523:psychology; D000674:Amputees / Q000523:psychology*; D001158:Arteries / Q000293:injuries / Q000601:surgery*; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D007869:Leg Injuries / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D012944:Social Support; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000523:psychology; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000601:surgery*
keywords: Amputation; Phenomenological; Qualitative; Reconstruction; Vascular injury; Vascular surgery