The Mangled Foot and Leg: Salvage Versus Amputation - 21/08/11

Doi : 10.1016/j.fcl.2009.11.005

Scott B. Shawen, MD ^a,^b,^c,^d,^⁎ , John J. Keeling, MD ^b,^c,^e,^f,^g, Joanna Branstetter, MD ^h, Kevin L. Kirk, DO ^i,^j, James R. Ficke, MD ^k
^a Orthopaedic Foot and Ankle Service, Walter Reed Army Medical Center (WRAMC), 6900 Georgia Avenue NW, Washington, DC 20307, USA
^b Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
^c Orthopaedic Surgery Service, Walter Reed National Military Medical Center (WRNMMC), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
^d Orthopaedic Surgery Residency, National Capital Consortium, Bethesda, MD, USA
^e Orthopaedic Surgery Service, National Naval Medical Center, 8901 Rockville Pike, Bethesda, MD 20889-5600, USA
^f Orthopaedic Foot and Ankle Service, National Naval Medical Center (NNMC), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
^g Orthopaedic Surgery Service, Walter Reed National Military Medical Center (WRNMMC), 6900 Georgia Avenue NW, Washington, DC, USA
^h Orthopaedic Surgery Service, Madigan Army Medical Center, Fitzsimmons Drive, Building 9404, Tacoma, WA 98431, USA
ⁱ LTC Kevin L. Kirk, DO, Chief, Integrated Orthopedic Surgery Service San Antonio Military Medical Center, San Antonio, Texas; Assistant Professor, Baylor University, School of Graduate Studies, Houston, Texas
^j Baylor University, School of Graduate Studies, Houston, TX, USA
^k Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA

Corresponding author. Orthopaedic Foot and Ankle Service, Walter Reed Army Medical Center (WRAMC), 6900 Georgia Avenue NW, Washington, DC 20307.

Résumé

Determining whether to perform limb salvage or amputation in the traumatized lower extremity continues to be a difficult problem in the military and civilian sectors. Numerous predictive scores and models have failed to provide definitive criteria for prediction of limb-salvage success. Excellent support is available in the military health care system for soldiers electing to undergo either limb salvage or amputation. Recent experience with soldiers who sustained limb-threatening injuries has shown that delayed amputation after limb-salvage attempts is a viable option for soldiers wounded in combat.

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Keywords : Limb salvage, Amputation, Trauma, Foot, Ankle