Review Question - QID 211265

Patients who undergo limb salvage requiring free flaps and/or ankle arthrodesis have significantly worse outcomes at two-years compared to patients treated with below the knee amputation (BKA).

The Sickness Impact Profile (SIP) evaluates the impact of disease on physical and emotional functioning and is based on 12 categories, which include psychosocial and physical dimensions. A higher SIP score means the patient has a higher disability. Patients with mangled foot and ankle injuries requiring free tissue transfer or ankle arthrodesis for limb salvage have higher SIP scores than patients who undergo BKA.

Ellington et al. prospectively evaluated mangled foot and ankle cases in the Lower Extremity Assessment Project (LEAP) study. They found patients that had undergone limb salvage, with or without a free tissue transfer or ankle arthrodesis, had significantly more rehospitalizations and longer times to full weight-bearing comparted with BKA. The authors concluded that patients with severe foot and ankle injuries requiring free tissue transfer or ankle fusion have significantly worse SIP scores when compared to those undergoing BKA with typical closures.

Harris et al. described complications following limb-threatening lower extremity trauma. The authors note that patients with severe lower extremity injuries often experience a significant number of complications which include infection, nonunion, wound necrosis, and osteomyelitis. Wound infections were the most common complication in those who at undergone an amputation, affecting 51 of the 149 patients (34.2%). Complications affecting the 371 patients who underwent limb reconstruction included 117 (31.5%) with fracture nonunion, 86 (23.3%) wound infections, 32 (8.6%) reports of osteomyelitis, and 25 (3.9%) late amputations. They conclude patients electing for reconstruction can expect a higher risk of complications.

Incorrect Answers
Answer 1 & 2: The LEAP study demonstrated no difference in walking speeds or return to work rates between the two groups.
Answer 3: The LEAP study demonstrated longer times to full weight-bearing in patients that had undergone limb salvage when compared to BKA.
Answer 5: Limb salvage patients are more likely to be rehospitalized when compared to BKA.