TY  - JOUR
PY  - 2020//
TI  - Factors associated with primary and secondary amputation following limb-threatening upper extremity trauma
JO  - Plastic and reconstructive surgery
A1  - Nawijn, Femke
A1  - Westenberg, Ritsaart F.
A1  - Langhammer, Chris G.
A1  - Chen, Neal C.
A1  - Eberlin, Kyle R.
SP  - 987
EP  - 999
VL  - 145
IS  - 4
N2  - BACKGROUND: The aim of this study was to assess the factors associated with primary and secondary amputation in patients with limb-threatening trauma to the upper extremity, describe the incidence of these injuries, and describe the procedures involved in the treatment of these difficult injuries. <br><br>METHODS: A retrospective study of 49 cases (in 47 patients) with acute limb-threatening trauma of the upper extremity proximal to the carpometacarpal joint level treated with either amputation or limb salvage was performed in two urban level I trauma centers between January of 2001 and January of 2018. <br><br>RESULTS: Bivariate analysis demonstrated that cases of primary amputation more frequently had a higher Injury Severity Score, higher Abbreviated Injury Scale score, more proximal fractures, more severe muscle injuries, and a larger number of major nerve injuries. Secondary amputation, compared with limb salvage, was more frequently performed in patients who were younger, in cases with a higher Injury Severity Score, where there was more proximal soft-tissue injury, in case of nonsharp mechanism of injury, and in cases that required local flap procedures for wound closure. The authors found a yearly incidence of 62 cases of acute limb-threatening upper extremity trauma per 100,000 trauma admissions. <br><br>CONCLUSIONS: Multiple factors influence the surgical decision to perform primary amputation or to attempt a salvage procedure following limb-threatening upper extremity trauma. Knowing which patients will have the most favorable outcomes of a salvage procedure is important, because salvage procedures impose a greater burden on the health care system and the patient, even more so in the case of secondary amputation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.<p />  <p>Language: en</p>
LA  - en
SN  - 0032-1052
UR  - http://dx.doi.org/10.1097/PRS.0000000000006644
ID  - ref1
ER  -