• David D Krijgh, Teun Teunis, Emile B List, MureauMarc A MMAMDepartment of Plastic and Reconstructive Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands., Antonius J M Luijsterburg, Wiesje Maarse, Pascal P A Schellekens, Falco Hietbrink, Tim de Jong, and J Henk Coert.
• Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, Postbus, 85500, Postcode 3508, GA, Utrecht, the Netherlands. d.d.krijgh@umcutrecht.nl.
• Eur J Trauma Emerg Surg. 2024 Jan 30.

BackgroundKnowledge about factors associated with long-term outcomes, after severe traumatic injury to the lower extremity, can aid with the difficult decision whether to salvage or amputate the leg and improve outcome. We therefore studied factors independently associated with capability at a minimum of 1 year after amputation or free flap limb salvage.MethodsWe included 135 subjects with a free flap lower extremity reconstruction and 41 subjects with amputation, between 1991 and 2021 at two urban-level 1 trauma centers with a mean follow-up of 11 ± 7 years. Long-term physical functioning was assessed using the Physical Component Score (PCS) of the Short-Form 36 (SF36) and the Lower Extremity Functional Scale (LEFS) questionnaires. Independent variables included demographics, injury characteristics, and the Mental Component Score (MCS) of the SF36.ResultsGreater mental health was independently and strongly associated with greater capability, independent of amputation or limb reconstruction. Mental health explained 33% of the variation in PCS and 57% of the variation in LEFS. Injury location at the knee or leg was associated with greater capability, compared to the foot or ankle. Amputation or limb reconstruction was not associated with capability.DiscussionThis study adds to the growing body of knowledge that physical health is best regarded through the lens of the bio-psycho-social model in which mental health is a strong determinant. This study supports making mental health an important aspect of rehabilitation after major lower extremity injury, regardless of amputation or limb salvage.© 2024. The Author(s).

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