Salvage of a severely mangled limb following traumatic injury.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Competing interests: None declared. 19. Acta Cardiol Sin. 2022 Jul;38(4):455-463. doi: 10.6515/ACS.202207_38(4).20220128A. Vascular Trauma in the Extremities: Factors Associated with the Outcome and Assessment of Amputation Indexes. Lee CH(1), Chang YJ(2), Li TS(1), Chen YC(1), Hsieh YK(1). Author information: (1)Division of Cardiovascular Surgery. (2)Big Data Center, Changhua Christian Hospital, Changhua, Taiwan. BACKGROUND: Traumatic vascular injury in the extremities may be associated with a low mortality rate but can lead to limb loss that seriously affects patients' functionality. Multiple scoring systems have been designed to evaluate the prognosis, but none are 100% predictive. The management of traumatic vascular injury remains challenging and depends mostly on the surgeon's experience. OBJECTIVES: We identified the risks associated with limb loss and further investigated the utility of current amputation indexes. METHODS: We retrospectively reviewed 53 cases of traumatic vascular injury in the extremities at a tertiary referral medical center over the past ten years (January 2011-December 2020). The mangled extremity severity score (MESS), limb salvage index (LSI), and predictive salvage index (PSI) were used to assess the traumatized limbs. The injury characteristics and outcomes were evaluated using regression analysis. RESULTS: The incidence of limb loss was 20.8% (n = 11), and open fractures were the most related factor. Extensive involvement of soft tissue, vascular injury combined with tibia or fibula fractures, initial shock status, and the amount of transfusion were associated with limb loss. CONCLUSIONS: Our study identified the risk factors and clinical utility of MESS, PSI, and LSI. While both LSI and PSI had acceptable diagnostic accuracy, amputation should be decided based on a variety of criteria and clinical features. Salvaging any limb that has not become apparently futile seems logical, yet the presence of certain factors may suggest a worse outcome. DOI: 10.6515/ACS.202207_38(4).20220128A PMCID: PMC9295044