Abstract
Background and Aim: Surgical site infection is the most frequent complication after limb amputation for severe blunt trauma. Numerous emergency operation methods for amputation have been developed to minimize infection. Since 2008, our institution has changed the strategy for surgical procedures from primary suture to second-look surgery because a few infection cases resulted after initial surgery. Here, we attempted to determine whether the new strategy has improved post-surgical infection rates.
Materials and Methods: Nineteen limb amputations were performed at our institution between 2006 and 2010. We divided these cases into two groups according to the strategy used: primary suture (11 limbs) and second-look surgery (8 limbs), respectively. We investigated the post-surgical infection rates between the two groups and between upper and lower limb amputations.
Results: No significant differences in the patients' backgrounds, such as age, gender, ISS, and MESS were detected between the two groups, except hemorrhagic shock. The infection rates of the primary suture and second-look surgery groups were 45% and 0% for total limbs (p=0.0395), 17% and 0% for upper limbs (p=0.6), and 80% and 0% for lower limbs (p=0.0397), respectively. The differences in the rates for total and lower limbs were statistically significant between the two groups. In addition, two cases of amputation over the proximal joint did not develop infection.
Discussion and Conclusion: Based on the markedly lower infection rates observed in amputation patients who received second-look surgery, we propose that this treatment strategy should be considered in cases of emergency amputation after severe blunt trauma to prevent post-surgical infection, which frequently develops due to the damaged or necrotic soft tissue remained after initial surgery. However, in cases of amputation at the upper limb or over the proximal joint, second-look surgery may not be necessary.
