FACTORS CONTRIBUTING TO DELAYED EXTREMITY AMPUTATION IN BURN PATIENTS

Background: Previous series of traumatic amputations have noted that d elay in amputation results in prolonged hospital stay and delayed reha bilitation. A series of major extremity amputations after burn injury was analyzed to identify the frequency of delayed amputation and to id entify factors resulting in the delay. Methods: Chart review of burn a dmissions between January of 1991 and December of 1995, Results: Twent y-eight patients underwent a total of 14 major extremity amputations. Thirty-five amputations in 22 patients were performed by postburn day 16 (mean 4.3), Nine amputations in six patients were delayed beyond po stburn day 26 (mean, 48.3). Delayed amputations occurred in the subgro ups of deep thermal burns with extensive necrosis and thermal burns co mplicated by infections. Early amputation was associated with a 13.6% mortality rate, delayed amputation with a 50% mortality rate. Conclusi on: There is a bimodal distribution of time to amputation determined b y mechanism of injury, severity of burn, and infectious complications. Earlier identification of nonsalvageable limbs may decrease infectiou s complications and improve the chances of patient survival.