Traumatic and Trauma-Related Amputations

Abstract

In the United States alone, approximately 185,000 amputations are performed annually, with about 16% of these being related to trauma. Despite this relatively low proportion of amputations done following trauma, individuals with a traumatic amputation account for nearly 45% of the estimated 1.6 million living people with an amputation. This striking disparity highlights the most important difference between trauma-related amputations and those performed on more elderly or infirm individuals for other indications. Trauma-related amputations are usually performed on young and previously healthy patients with substantial predicted longevity as well as a high potential for rehabilitation to regain previous levels of activity. Historically, it was believed that individuals with a traumarelated amputation rapidly adapted to the loss of the limb and proceeded to lead functional and productive lives. Unfortunately, this proposition has not been substantiated by the literature, and it is now recognized that the postoperative course following a trauma-related amputation is fraught with complications and difficulties. In a review highlighting the difficulties facing these individuals, Pierce et al. indicated that nearly 51% of their sixty-one patients developed an anatomic complication related to their amputation. This difficult postoperative course has also been recognized and discussed by the Lower Extremity Assessment Project (LEAP) study group. The authors of the LEAP study reported a rehospitalization rate of 29.8% and a 14.5% rate of revision of the residual limb in their series of 149 patients treated with trauma-related amputation. Nonetheless, 6.5% of the 124 patients followed for twenty-four months still did not have fully healed soft tissues. Most importantly, a large percentage of these patients