Reconstruction versus amputation in patients with serious lesions of the lower limb. Recommendations based on evidence for the Clinical Practice Guideline in persons with amputation of the lower limb in Colombia
DOI:
https://doi.org/10.17533/udea.iatreia.323383Keywords:
amputation, prosthesis, quality of life, reconstructionAbstract
The Ministry of Health and Social Protection in Colombia and the University of Antioquia in partnership with the Javeriana University, the National University of Colombia, the Colombian associations of Physical Medicine and Rehabilitation and of Physical Therapy, developed The Clinical Practice Guideline for the diagnosis and preoperative, intraoperative and postoperative treatment of the amputee, the prosthesis prescription and the comprehensive rehabilitation. In this article the evidence and recommendations found as to the decision to amputate or reconstruct in the patient with severe limb injury are summarized. The results found in 3 systematic reviews and 10 observational studies are contradictory in terms of function, job reinstatement, psychological aspects, additional surgeries, infection, and chronic pain. In the amputee there are fewer complications and less additional surgeries; disability, psychological aspects, infection, chronic pain and functional capacity are similar between reconstructed and amputated patients; however, in order to reduce costs and improve long-term function the developer group suggested carrying out reconstruction of the lower limb instead of amputation in patients over 16 years with severe limb trauma.
Downloads
References
(1.) Gage MJ, Yoon RS, Gaines RJ, Dunbar RP, Egol KA, Liporace FA. Dead Space Management After Orthopaedic Trauma: Tips, Tricks, and Pitfalls. J Orthop Trauma. 2016 Feb;30(2):64-70. DOI 10.1097/BOT.0000000000000454.
(2.) Brown BJ, Attinger CE. The Below-Knee Amputation: To Amputate or Palliate? Adv Wound Care (New Rochelle). 2013 Feb;2(1):30-35.
(3.) Rossiter ND, Higgins TF, Pallister I. (ii) The mangled extremity: Limb salvage versus amputation. Orthop Trauma. 2014 Jun;28(3):137-40. DOI 10.1016/j.mporth.2014.05.002.
(4.) Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008 Dec;122(6):1796-805. DOI 10.1097/PRS.0b013e31818d69c3.
(5.) Cole P. Open tibia fracture: amputation versus limb salvage. OPINION: limb salvage. J Orthop Trauma. 2007 Jan;21(1):68-9.
(6.) Hertel R, Strebel N, Ganz R. Amputation versus reconstruction in traumatic defects of the leg: outcome and costs. J Orthop Trauma. 1996;10(4):223-9.
(7.) Shawen SB, Keeling JJ, Branstetter J, Kirk KL, Ficke JR. The mangled foot and leg: salvage versus amputation. Foot Ankle Clin. 2010 Mar;15(1):63-75. DOI 10.1016/j.fcl.2009.11.005.
(8.) Russell WL, Sailors DM, Whittle TB, Fisher DF Jr, Burns RP. Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg. 1991 May;213(5):473-80; discussion 480-1.
(9.) Ministerio de la Protección Social, Colciencias, Centro de Estudios e Investigación en Salud de la Fundación Santa Fe de Bogotá, Escuela de Salud Pública de la Universidad de Harvard. Guía Metodológica para el desarrollo de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano. Bogotá: Ministerio de la Protección Social, COLCIENCIAS; 2010.
(10.) Andrews J, Guyat G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, et al. GRADE guidelines: 15. Going from evidence to recomendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013 Jul;66(7):719-25. DOI 10.1016/j.jclinepi.2012.03.013.
(11.) Akula M, Gella S, Shaw CJ, McShane P, Mohsen AM. A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective. Injury. 2011 Nov;42(11):1194-7. DOI 10.1016/j.injury.2010.05.003.
(12.) Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M; Evidence-Based Orthopaedic Trauma Working Group. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. J Orthop Trauma. 2007 Jan;21(1):70-6.
(13.) Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002 Dec;347(24):1924-31.
(14.) MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, et al. Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am. 2005 Aug;87(8):1801-9.
(15.) Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R; Lower Extremity Assessment Project (LEAP) Study Group. Complications following limb-threatening lower extremity trauma. J Orthop Trauma. 2009 Jan;23(1):1-6. DOI 10.1097/BOT.0b013e31818e43dd.
(16.) Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, et al. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013 Jan;95(2):138-45. DOI 10.2106/JBJS.K.00734.
(17.) Melcer T, Sechriest VF, Walker J, Galarneau M. A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars. J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2):S247-54. DOI 10.1097/TA.0b013e318299d95e.
(18.) Tekin L, Safaz Y, Göktepe AS, Yazýcýodlu K. Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery. Prosthet Orthot Int. 2009 Mar;33(1):17-24. DOI 10.1080/03093640802482542.
(19.) Hoogendoorn JM, van der Werken C. Grade III open tibial fractures:
functional outcome and quality of life in amputees versus patients with successful reconstruction. Injury. 2001 May;32(4):329-34.
(20.) Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg. 1999 Apr;103(4):1212-20.
(21.) Georgiadis G, Behrens F, Joyce M et al. Open Tibial Fractures with Severe Soft Tissue Loss. J Bone Jt Surg Am. 1993;75(10):1431.41.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Iatreia
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
