Reoperation and complication rates in acute lower limb amputations due to trauma

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Aims: Lower limb amputation is associated with significant morbidity and mortality. Reflecting the predominance of vascular or diabetic disease as a cause for lower limb amputation, much of the available literature excludes lower limb amputation secondary to trauma in the reporting of complication rates. This paucity of literature represents a research gap in describing the incidence of complications in lower limb amputations due to trauma, which we aim to address. Methods: A retrospective analysis was undertaken of a prospectively collected database of lower limb amputations secondary to trauma from a regional multidisciplinary amputee service in London. Clinical records were consulted for evidence of reoperation, infection, phantom limb pain, neuroma, and contralateral limb arthritis. A multivariable regression model was created to establish risk factors for reoperation. A total of 213 amputations (200 patients) were included in the final analysis. Results: Mean age at amputation was 33 years (1 to 90), with a mean follow-up of 230 months (2 to 734). Overall, 35.2% of patients (n = 75) underwent reoperation, and 27.7% (n = 59) had at least one episode of infection. Of those who underwent reoperation, 44% (n = 33) had evidence of infection. Phantom limb pain and neuroma were reported in 39.9% (n = 85) and 10.8% (n = 23), respectively. Contralateral limb osteoarthritis was documented in 7%. Presence of infection is a statistically significant risk factor, conferring a 3.9 times increased risk of reoperation. Conclusion: Lower limb amputations secondary to trauma exhibit higher rates of reoperation and infection compared to vascular or diabetic amputees. This is the first and largest study to provide high-quality data describing the incidence of complications in patients with lower limb amputations due to trauma in the UK.

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