scholarly journals Primary amputation versus limb salvage in upper limb major trauma: a systematic review

2021 ◽  
Author(s):  
Sandeep Krishan Nayar ◽  
Harry M. F. Alcock ◽  
Dafydd S. Edwards
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Limb Salvage ◽  
Upper Limb ◽  
Major Trauma ◽  
Scoring Systems ◽  
Psychological Outcomes ◽  
Mangled Extremity ◽  
Primary Amputation ◽  
Limb Injuries

Abstract Purpose Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate indications for amputation versus limb salvage in upper limb major trauma and whether any existing scoring systems can aid in decision-making. Secondary objectives were to assess the functional and psychological outcomes from amputation versus limb salvage. Methods A systematic review was carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. The review protocol was registered in PROSPERO. Results A total of 15 studies met inclusion criteria, encompassing 6113 patients. 141 underwent primary amputation and 5972 limb salvage. General indications for amputation included at least two of the following: uncontrollable haemodynamic instability; extensive and concurrent soft tissue, bone, vascular and/or nerve injuries; prolonged limb ischaemia; and blunt arterial trauma or crush injury. The Mangled Extremity Severity Score alone does not accurately predict need for amputation, however, the Mangled Extremity Syndrome Index may be a more precise tool. Comparable patient-reported functional and psychological outcomes are seen between the two treatment modalities. Conclusions Decision regarding amputation versus limb salvage of the upper limb is multifactorial. Current scoring systems are predominantly based on lower limb trauma, with lack of robust evidence to guide management of the upper extremity. Further high-quality studies are required to validate scoring systems which may aid in decision-making and provide further information on the outcomes from the two treatment options.

Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

Vascular ◽  
2005 ◽  
Vol 13 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Mohamed Amin Elsharawy
Keyword(s):  
Prospective Study ◽  
Limb Salvage ◽  
Upper Limb ◽  
Injury Severity ◽  
University Hospital ◽  
Secondary Patency ◽  
Arterial Reconstruction ◽  
Mangled Extremity ◽  
Limb Injuries ◽  
A Prospective Study

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

399 Complex Limb Injuries – Limb Salvage vs Amputation: An Overview of the Factors Influencing Decision-Making and Outcomes

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Jamal ◽  
A Sheeraz
Keyword(s):  
Decision Making ◽  
Limb Salvage ◽  
Scoring System ◽  
Scoring Systems ◽  
Psychological Status ◽  
Limb Amputation ◽  
Secondary Outcome ◽  
Initial Examination ◽  
Joint Decision ◽  
Limb Injuries

Abstract Aim Complex limb injuries usually comprise of a combination of osseous, soft tissue, vascular and neural damage, necessitating prompt and accurate initial examination and decision-making to maximise optimal patient outcomes. We present the factors affecting the decision-making as well as the outcomes following primary limb amputation or salvage of complex extremity injuries, with an emphasis on the various scoring systems present that endeavour to offer prognostic and therapeutic guidance to orthopaedic surgeons. Method We performed the literature search on PubMed and Embase, and collated the relevant data comprising of demographics, injury, scoring system, primary and secondary outcome metrics and complications. Results Many scoring systems, each with variable factors, have been proposed to predict limb salvage vs amputation in complex extremity injury (MESS, PSI, LSI, NISSSA, HFS-97), however the landmark LEAP trial concluded in its final analysis that they could not validate them. Whilst the scores were useful in predicting limb salvage, they were inaccurate and unreliable in predicting amputation with low sensitivities Conclusions Many scoring systems attempt to provide guidance regarding decision-making in limb salvage vs primary amputation, however the LEAP study has shown poor predictive standards of these systems. As such, there is no gold standard algorithmic approach or scoring system when making this difficult decision – instead, the poor predictors of limb salvage have been identified, and the surgeons need to be judicious and make a joint decision considering these variables and other patient factors (social, economic, and psychological status).

scholarly journals The validity of the mangled extremity severity score in the assessment of upper limb injuries

2005 ◽  
Vol 87-B (11) ◽  
pp. 1516-1519 ◽  
Author(s):  
S. Togawa ◽  
N. Yamami ◽  
H. Nakayama ◽  
Y. Mano ◽  
K. Ikegami ◽  
...  
Keyword(s):  
Upper Limb ◽  
Severity Score ◽  
Mangled Extremity ◽  
Limb Injuries

scholarly journals Systematic review protocol examining the influence of surgeon personality on perioperative decision making in abdominal surgery

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e035361 ◽  
Author(s):  
Carly Nichola Bisset ◽  
Tracey McKee ◽  
Elliot Tilling ◽  
Mary Cawley ◽  
Susan Moug
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Abdominal Surgery ◽  
Search Strategy ◽  
Meta Analysis ◽  
Scoring Systems ◽  
Postoperative Outcomes ◽  
Narrative Synthesis ◽  
Review Team ◽  
The Impact

IntroductionThere is limited published literature exploring how the personality traits of surgeons may influence preoperative decision making, particularly in the context of visceral/abdominal surgery. Multiple validated personality scoring systems exist and have been used to describe surgeon personalities previously. The degree to which each trait is expressed by abdominal surgeons is neither currently known, nor the impact of these traits on postoperative outcomes. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.Methods and analysisThe search strategy has been developed by a Health Scientist Librarian in collaboration with the review team. The search was conducted on 1st October 2019.Database subject headings and text words relating to ‘abdominal/general surgeons’, ‘personality’, ‘postoperative outcomes’ and ‘decision making’ formed the basis of our literature search strategy; the MEDLINE, EMBASE, PsycInfo and Cochrane databases will be searched. Three reviewers will independently screen and appraise articles, with a fourth reviewer utilised if disagreements arise.A systematic narrative synthesis will be performed, with information presented in text and table format. These will summarise the findings and characteristics of any included studies. Using guidance from the Centre for Reviews and Dissemination, the reviewers will describe the potential relationship and findings between studies using the narrative synthesis. Studies will only be reported if they are felt to have low or mid-levels of bias. Studies felt to display high levels of bias will be excluded.Ethics and disseminationThis study does not require ethical approval. The formal systematic review will be submitted for peer reviewed publication and presented at relevant conferences. The methods may inform future reviews in other surgical specialties regarding surgeon personality.PROSPERO registration numberCRD42019151375.

Limb salvage in a child with severely injured mangled lower extremity and muscle rigor

Vascular ◽  
2012 ◽  
Vol 20 (6) ◽  
pp. 321-324 ◽  
Author(s):  
Mohamed A Elsharawy ◽  
Karay Maher ◽  
Aymen S Elsaid
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Clinical Picture ◽  
Scoring Systems ◽  
Severely Injured ◽  
Ischemic Limb ◽  
Mangled Extremity ◽  
Severity Scores

Most surgeons make their decision to amputate or perform limb salvage of a mangled extremity based on scoring systems and grading of acute ischemic limb. We report on a child in whom limb salvage was achieved in spite of a clinical picture of irreversible ischemia with high mangled severity scores. Attempts to revascularize the mangled extremity of children are recommended, regardless of their severity scores and condition of the foot.

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