Parameters of multiple organ dysfunction fail to predict secondary amputation following limb salvage in multiply traumatized patients

Objective: the purpose of this retrospective analysis was to evaluate wheth er systemic parameters that are used to characterize multiple organ dysfunc tion could also be used to predict the optimal time for amputation in patie nts failing limb salvage surgery following severe extremity injury. Methods: the principal criterion for the study group was a lower limb amput ation following a type IIIb or IIIc open tibial shaft fracture in multiply traumatized patients. This group was then divided into one group of primary amputation (group A) and one group of secondary amputation (group B). Besi de these groups a third group of total traumatic lower limb amputation was recruited (group C). Data analysis included demographics, injury severity a ccording to the ISS, evaluation of the limb injury by three different salva ge scores (HFS, MESS and NISSSA) and organ function monitoring by the Denve r MOD Score over a 14-day period posttrauma or up to 7 days after secondary amputation. Results: within the period 1987-1997 a total of 15 patients were recruited for group A (primary amputation), 10 patients for group B (secondary amputa tion) and nine patients for group C (traumatic amputation). The MOD score w as only positive for pulmonary dysfunction, also reflected by the Horovitz quotient, in those patients that died later in either group. Mortality was higher in group A (three out of 15) compared with group B tone out of 10, w hich may be due to a higher ISS in group A (mean ISS 28.2 vs. 21.0 of group B). Although the MOD score of all recovered patients revealed no significa nt difference between group A and B, secondary amputation resulted in signi ficantly longer demand of mechanical ventilation. According to our results secondary amputation may lead to transiently decreased pulmonary function b ut does not necessarily end in multiple organ dysfunction. The need for amp utation in failed limb salvage was not indicated by systemic parameters. Conclusion: the right time for secondary amputation in order to prevent sub sequent pulmonary dysfunction cannot be predicted by parameters otherwise i ndicating organ dysfunction. As the risk of secondary amputation for develo ping pulmonary dysfunction apparently cannot be estimated the decision for amputation or limb salvage should be made initially after trauma and should be the definite one. (C) 1999 Elsevier Science Ltd, All rights reserved.