DECISION MAKING TO SALVAGE OR AMPUTATE A SEVERELY INJURED LIMB

Abstract

The decision to salvage or amputate a severely injured limb is one of the most difficult an orthopaedic surgeon may face. The inclination to undertake heroic measures to save the limb should be tempered by the realization that doing so may lead to repeated hospitalizations, extensive complications, and a poor functional outcome.

Such a decision is rarely clear-cut. Several factors require consideration: the degree of damage to the extremity and the severity of the overall injury, as well as the nature of the patient’s physical, psychologic, social, and economic status, including such aspects as age, previous state of health, attitude, wishes, reliability, support system, life-style, occupation, and financial resources.

In this study We present 36 cases of severe limb injury with arterial damage. In our cases we evaluate the efficacy of limb injury scoring system like MESS score, MESI score, NISSSA score, LSI and PSI system in predicting results of limb saving surgery.

Scoring systems should be used only as a guide for decision making. The relative importance of each of the associated trauma parameters (with the exception of prolonged, warm ischaemia time or risking the life of a patient with severe, multiple organ trauma) is still of questionable predictive value. A good understanding of the potential complications facilitates the decision-making process in limb salvage versus amputation.

The subjective factors include such aspects as lifestyle, occupation, age, wishes, attitude, reliability, social support system, and financial resources. These considerations are perhaps more subjective, but undoubtedly important, for man is more than his framework of tendons, veins, and bones.