Factors Associated with Primary and Secondary Amputation following Limb-Threatening Upper Extremity Trauma. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Nawijn, Femke; Westenberg, Ritsaart F.; Langhammer, Chris G.; Chen, Neal C.; Eberlin, Kyle R.
• Is Part Of: Plastic and reconstructive surgery. Volume 145:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000006644
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: The aim of this study was to assess the factors associated with primary and secondary amputation in patients with limb-threatening trauma to the upper extremity, describe the incidence of these injuries, and describe the procedures involved in the treatment of these difficult injuries. Methods: A retrospective study of 49 cases (in 47 patients) with acute limb-threatening trauma of the upper extremity proximal to the carpometacarpal joint level treated with either amputation or limb salvage was performed in two urban level I trauma centers between January of 2001 and January of 2018. Results: Bivariate analysis demonstrated that cases of primary amputation more frequently had a higher Injury Severity Score, higher Abbreviated Injury Scale score, more proximal fractures, more severe muscle injuries, and a larger number of major nerve injuries. Secondary amputation, compared with limb salvage, was more frequently performed in patients who were younger, in cases with a higher Injury Severity Score, where there was more proximal soft-tissue injury, in case of nonsharp mechanism of injury, and in cases that required local flap procedures for wound closure. The authors found a yearly incidence of 62 cases of acute limb-threatening upper extremity trauma per 100, 000 trauma admissions. Conclusions: Multiple factors influence the surgical decision to perform primary amputation or to attempt a salvage procedure following limb-threatening upper extremity trauma. Knowing which patients will have the most favorable outcomes of a salvage procedure is important, because salvage procedures impose a greater burden on the health care system and the patient, even more so in the case of secondary amputation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. Abstract : Supplemental Digital Content is available in the text.