Background
Lower extremity vascular trauma (LEVT) is a potentially devastating injury that may result in death, profound disability or limb loss. Management priorities are clear: foremost to save the patient's life, and second to salvage the most functional limb possible. Severe LEVT, however, presents some of the most challenging decision-making in trauma surgery. A clear understanding of predictive factors for amputation is therefore important to inform surgical decision-making, patient counselling and calculating risks. Towards that end, we have been studying predictive factors for amputation following surgical repair of LEVT
Study Methods
We undertook a systematic review of the published literature with the objective of developing an understanding of predictive factors for amputation following surgical repair of LEVT. Our first aim was to estimate the overall risk of amputation following LEVT repair; second, identify potential patient, injury and treatment predictive factors; and, finally, to measure the strength of association between the identified predictive factors and amputation.
Results
Approximately one in ten limbs that undergo vascular repair will require amputation, the rate of which varies depending on specific patient and injury characteristics. Factors associated with a substantial increase in amputation include: mechanism of injury, injuries to arteries, fracture or major soft tissue injury, duration of ischaemia (restriction in blood supply to tissues) exceeding 6 hours, compartment syndrome (bleeding or swelling within a bundle of muscles) and the surgical method of vascular repair. By comparison, demographic factors, such as older age and female sex, and shock on admission were associated with smaller increases, whereas additional venous or nerve injuries were not associated with an important increase in secondary amputation.
Potential predictive factors identified from the systematic literature review & the evidence supporting an association with secondary amputation (2000-2012)
We aim to use this improved understanding of severe lower limb trauma prediction to develop tools that support surgical decision-making, and allow more accurate communication of risk with colleagues, patients and family.
More information in this article: 'Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma' (2016)
