gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Early Amputation vs Limb Salvage: Characterization of Procedural Management for Limb Threatening Upper Extremity Injuries in Hospital Days 1 to 30

Meeting Abstract

  • presenting/speaker R. F. Westenberg - Massachusetts General Hospital, Boston, United States
  • Chris Langhammer - Massachusetts General Hospital, Boston, United States
  • Femke Nawijn - Massachusetts General Hospital, Boston, United States
  • K. Eberlin - Massachusetts General Hospital, Boston, United States
  • N. C. Chen - Massachusetts General Hospital, Boston, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1303

doi: 10.3205/19ifssh0493, urn:nbn:de:0183-19ifssh04930

Veröffentlicht: 6. Februar 2020

© 2020 Westenberg et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: There is little quantitative data regarding the acute care burden for patients with upper-extremity threatening injuries. This study characterizes procedural care provided for a cohort of patients with acutely limb-threatening traumatic upper-extremity injuries at an urban level-1 trauma referral center based on the decision to perform early amputation versus limb salvage.

Methods: Retrospective chart review of an institutional database from 2010 - 2017 was performed, identifying patients who were diagnosed with upper-extremity amputation or treated with extremity replant at a level proximal to the MCP joints. Patients were excluded for atraumatic mechanism of injury or for incomplete records. Patient and injury demographics as well as the sequence of procedural management were extracted through chart review.

Results: 22 patients met inclusion criteria; 6 underwent early amputation (EA cohort), 16 attempted limb salvage (LS cohort). There was a 63% limb salvage rate. The EA cohort was more severely injured (average ISS: EA = 54, LS = 33; p = .02), and had more proximal injuries (Table 1). Differences in the average length of ICU admission (EA = 11d vs. LS = 9d), inpatient admission (EA = 19d vs. LS = 23d), or number of upper-extremity procedures during the first 30 days (EA = 3.0 vs. LS = 4.3), did not reach statistical significance. In the EA cohort, only 4 procedure types (I&D, amputation, wound closure, and local flaps) accounted for 75% of upper extremity interventions. In the LS cohort, 6 additional procedure types (ORIF, external fixation, tendon repair, fasciotomies, skin graft, and vessel anastomosis) were needed to account for 75% of upper extremity interventions. Free tissue transfer was ultimately performed in 4 of 22 patients (18%) (Figure 1).

Conclusions: This study demonstrates that LS cohort patients had less extreme global injuries. However, the frequency of their procedural interventions and length of ICU and inpatient admissions did not significantly differ from the EA cohort. Additionally, attempted limb salvage required inclusion of orthopaedic and microsurgical skills not required for early amputation. This information may be used to instruct institutional decision making regarding team composition, training, and resource allocation required to maintain limb salvage programs.