• Femke Nawijn, Ritsaart F Westenberg, Chris G Langhammer, Neal C Chen, and Kyle R Eberlin.
• From the Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital; and the Department of Surgery, University Medical Center Utrecht.
• Plast. Reconstr. Surg. 2020 Apr 1; 145 (4): 987-999.

BackgroundThe 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.MethodsA 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.ResultsBivariate 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.ConclusionsMultiple 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 EvidenceRisk, III.

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