Options of limb salvage or amputation in severe limb injuries

ZHAN Jie; WU Jin-sheng; SUN Peng; MA Jun-wei; SHEN Lin; XING Chang-tai

doi:10.3969/j.issn.2095-252X.2015.12.008

Abstract：Objective To investigate options ( limb salvage or amputation ) in the treatment of severe limb injury by analyzing patients collected within 5 years retrospectively. Methods Based on MESS scoring system, general condition, limb function prediction and will of patients and their families were collected to conduct analysis. One hundred and sixty-six patients ( 169 limbs ) were divided into 3 groups. Group A ( 64 patients, 65 limbs ): MESS score>9. Group B ( 41 patients, 41 limbs ): MESS score <7, had limb salvage. Group C ( 61 patients, 63 limbs ): ≤MESS score 7-9, had limb salvage trail. Most of the limb salvage surgeries underwent I emergency revascularization surgery and II reconstruction surgery of bone, skin and soft tissues. Duration of treatment: the longest 30 months. Operation time: 8 times at most. Results Group A: all patients ( 64 patients, 65 limbs ) were conducted amputation. Group B:limb salvage in 41 patients, delayed amputation in 3 patients, salvage succeeded in 38 patients, success rate 92.6%. Group C: limb salvage in 59 patients ( 61 limbs ) , multiple organ failure and death in 1 patient, delayed amputation in 17 patients, salvage succeeded in 43 limbs, success rate 68.3%. Group B+Group C: salvage succeeded in 79 patients ( 81 limbs ), satisfactory results were achieved in 77 patients, 2 patients with poor effects. Conclusions Microsurgery technique guarantees limb salvage. The principle of limb salvage or amputation: life comes first, limbs come second. MESS scoring system is a basic, objective, and effective judgment standard of limb salvage, while other factors should also be taken into account. Severely injured patients of MESS score 7-9 may be conducted limb salvage.