Article Data

  • Views 137
  • Dowloads 18

Original Research

Open Access

Association of clinical characteristics with decision making in patients with severe lower extremity trauma

  • Vahide Aslıhan Durak1
  • Cenk Ermutlu2
  • Teoman Atıcı2

1Department of Emergency Medicine, Bursa Uludag University Medical Faculty, Bursa, Turkey

2Department of Orthopaedics and Traumatology, Bursa Uludag University Medical Faculty Bursa, Turkey

DOI: 10.22514/sv.2020.16.0103 Vol.17,Issue 1,January 2021 pp.89-94

Published: 08 January 2021

*Corresponding Author(s): Vahide Aslıhan Durak E-mail:


Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution’s emergency department for traumatic lower extremity amputation over an 8 years’ period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.


Amputation; Emergency department; Trauma

Cite and Share

Vahide Aslıhan Durak,Cenk Ermutlu,Teoman Atıcı. Association of clinical characteristics with decision making in patients with severe lower extremity trauma. Signa Vitae. 2021. 17(1);89-94.


[1] Fochtmann A, Binder H, Rettl G, Starlinger J, Aszmann O, Sarahrudi K, et al. Third degree open fractures and traumatic sub-/total amputations of the upper extremity: Outcome and relevance of the Mangled Extremity Severity Score. Orthopaedics & Traumatology: Surgery & Research. 2016; 102: 785-790.

[2] Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: Are the outcomes worth the means? Plastic & Reconstructive Surgery. 1999; 103: 1212-1220.

[3] Cimbanassi S, OʼToole R, Maegele M, Henry S, Scalea TM, Bove F, et al. Orthopedic injuries in patients with multiple injuries: Results of the 11th trauma update international consensus conference Milan, December 11, 2017. Journal of Trauma and Acute Care Surgery. 2020; 88: e53-e76.

[4] Biemer E. Definitions and classifications in replantation surgery. British Journal of Plastic Surgery. 1980; 33: 164-168.

[5] Gabel J, Jabo B, Patel S, Kiang S, Bianchi C, Chiriano J, et al. Analysis of patients undergoing major lower extremity amputation in the vascular quality initiative. Annals of Vascular Surgery. 2018; 46: 75-82.

[6] Tintle LSM, Keeling CJJ, Shawen LSB, Forsberg LJA, Potter MBK. Traumatic and trauma-related amputations. The Journal of Bone and Joint Surgery-American Volume. 2010; 92: 2852-2868.

[7] Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M. Complex limb salvage or early amputation for severe lower-limb injury: A meta-analysis of observational studies. Journal of Orthopaedic Trauma. 2007; 21: 70-76.

[8] Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. The New England Journal of Medicine. 2002; 347: 1924-1931.

[9] Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL. Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. The Journal of Bone & Joint Surgery. 1993; 75: 1431-1441.

[10] Rajasekaran S, Sabapathy SR, Dheenadhayalan J, Sundararajan SR, Venkatramani H, Devendra A, et al. Ganga hospital open injury score in management of open injuries. European Journal of Trauma and Emergency Surgery. 2016; 41: 3-15.

[11] Loja MN, Sammann A, DuBose J, Li CS, Liu Y, Savage S, et al. The mangled extremity score and amputation: Time for a revision. The Journal of Trauma and Acute Care Surgery. 2017; 82: 518-523.

[12] Schechtman DW, Walters TJ, Kauvar DS. Utility of the mangled extremity severity score in predicting amputation in military lower extremity arterial injury. Annals of Vascular Surgery. 2020; S0890-5096(20)30775-5.

[13] Johansen K, Daines M, Howey T, Helfet D, Hansen ST. Objective criteria accurately predict amputation following lower extremity trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 1990; 30: 568-573.

[14] Pouramin P, Li CS, Busse JW, Sprague S, Devereaux PJ, Jagnoor J, et al. Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study. The Lancet Global Health. 2020; 8: e711-e720.

[15] de Mestral C, Sharma S, Haas B, Gomez D, Nathens AB. A contemporary analysis of the management of the mangled lower extremity. Journal of Trauma and Acute Care Surgery. 2013; 74: 597-603.

[16] Pollak AN, Jones AL, Castillo RC, Bosse MJ, MacKenzie EJ, LEAP Study Group. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. The Journal of Bone and Joint Surgery. 2010; 92: 7-15.

[17] Hierner R, Berger AK, Frederix PR. Lower leg replantation-decision-making, treatment, and long-term results. Microsurgery. 2007; 27: 398-410.

[18] Märdian S, Schaser KD, Wichlas F, Jakobs C, Kraphol B, Schwabe P. Lower limb salvage: indication and decision making for replantation, revascularisation and amputation. Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca. 2015; 81: 9-21.

[19] Battiston B, Tos P, Pontini I, Ferrero S. Lower limb replantations: indications and a new scoring system. Microsurgery. 2002; 22: 187-192.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time