The mangled limb: salvage versus amputation.

Philip R Wolinsky, Lawrence X. Webb, Edward J. Harvey, Nirmal C. Tejwani

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

A mangled extremity is defined as a limb with injury to three of four systems in the extremity. The decision to salvage or amputate the injured limb has generated much controversy in the literature, with studies to support advantages of each approach. Various scoring systems have proved unreliable in predicting the need for amputation or salvage; however, a recurring theme in the literature is that the key to limb viability seems to be the severity of the soft-tissue injury. Factors such as associated injuries, patient age, and comorbidities (such as diabetes) also should be considered. Attempted limb salvage should be considered only if a patient is hemodynamically stable enough to tolerate the necessary surgical procedures and blood loss associated with limb salvage. For persistently hemodynamically unstable patients and those in extremis, life comes before limb. Recently, the Lower Extremity Assessment Project study attempted to answer the question of whether amputation or limb salvage achieves a better outcome. The study also evaluated other factors, including return-to-work status, impact of the level of and bilaterality of the amputation, and economic cost. There appears to be no significant difference in return to work, functional outcomes, or the cost of treatment (including the prosthesis) between the two groups. A team approach with different specialties, including orthopaedics, plastic surgery, vascular surgery and trauma general surgery, is recommended for treating patients with a mangled extremity.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalInstructional course lectures
Volume60
StatePublished - 2011

Fingerprint

Limb Salvage
Amputation
Extremities
Return to Work
Wounds and Injuries
Surgical Blood Loss
Soft Tissue Injuries
Plastic Surgery
Health Care Costs
Prostheses and Implants
Orthopedics
Blood Vessels
Comorbidity
Lower Extremity
Economics
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wolinsky, P. R., Webb, L. X., Harvey, E. J., & Tejwani, N. C. (2011). The mangled limb: salvage versus amputation. Instructional course lectures, 60, 27-34.

The mangled limb : salvage versus amputation. / Wolinsky, Philip R; Webb, Lawrence X.; Harvey, Edward J.; Tejwani, Nirmal C.

In: Instructional course lectures, Vol. 60, 2011, p. 27-34.

Research output: Contribution to journalArticle

Wolinsky, PR, Webb, LX, Harvey, EJ & Tejwani, NC 2011, 'The mangled limb: salvage versus amputation.', Instructional course lectures, vol. 60, pp. 27-34.
Wolinsky, Philip R ; Webb, Lawrence X. ; Harvey, Edward J. ; Tejwani, Nirmal C. / The mangled limb : salvage versus amputation. In: Instructional course lectures. 2011 ; Vol. 60. pp. 27-34.
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