• Michael J Bosse, Ellen J MacKenzie, James F Kellam, Andrew R Burgess, Lawrence X Webb, Marc F Swiontkowski, Roy W Sanders, Alan L Jones, Mark P McAndrew, Brendan M Patterson, Melissa L McCarthy, Thomas G Travison, and Renan C Castillo.
• Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA. mbosse@carolinas.org
• N. Engl. J. Med. 2002 Dec 12;347(24):1924-31.

BackgroundLimb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated.MethodsWe performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization.ResultsAt two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively).ConclusionsPatients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.Copyright 2002 Massachusetts Medical Society

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