Delayed Amputation Increases Residual Lower Limb Infection

A new study shows that delaying amputation of nonsalvageable lower limbs following trauma results in significantly more infections in the residual limb.

Researchers at the University of Oxford (United Kingdom) and Charing Cross Hospital (London, United Kingdom) reviewed 40 patients that underwent a total of 42 amputations (mean age 49 years) following nonsalvageable lower limb trauma. Amputations were performed for 21 Gustilo IIIB injuries, 12 multiplanar degloving injuries, seven IIIC injuries, and one open Schatzker 6 fracture. The patients were evaluated using a prospective database, and clinical and management variables were correlated with the development of deep infection in the residual limb.

The results showed that the median time from injury to amputation was four days, and that amputation following only one debridement and within five days resulted in significantly fewer stump infections. The cumulative probability of infection-free residual limb closure declined steadily from day five. Multivariate analyses revealed that neither the nature of the injury nor preinjury patient morbidity independently influenced residual limb infection. The study was published on December 11, 2012, in the Journal of Plastic, Reconstructive, & Aesthetic Surgery.

“Residual limb infection following amputation is a devastating complication, resulting in delayed rehabilitation, repeat surgery, prolonged hospitalization and poor functional outcome,” concluded lead author Abhilash Jain, MSc, MD, PhD. “Avoiding residual limb infection is critically dependent on prompt amputation of nonsalvageable limbs.”

Amputations above or below the knee are termed major, while amputations involving partial removal of a foot, including toe or forefoot resections, are termed minor. Trauma accounts for only 9% of major lower limb amputation, while the majority of cases in the developed world caused by peripheral vascular disease and the remaining amputations caused by infection secondary to diabetic foot ulceration.

Related Links:
University of Oxford
Charing Cross Hospital