Lower Extremity Assessment Project
Set up
Multicentre Prospective Outcome Study
- 601 patients
- severe, limb threatening lower extremity injuries
- 8 level 1 trauma centres
Inclusions
IIIC / IIIB / selected IIIA
- knee dislocations or closed tibial fractures associated with vascular injuries
- major ST injuries
- severe foot / ankle injuries (open pilon, type IIIB ankle)
Exclusions
GCS < 15 day 21
Third degree burns
Spinal cord deficit
Sensate sole
Bosse et al JBJS Am Dec 2005
3 groups of patients
1. 26 patients with insensate sole at time of admission who underwent amputation
2. 29 patients with insensate sole at time of admission who underwent limb salvage
3. Case matched group with sensate sole who underwent limb salvage
Assessed at 12 and 24 months
- orthopaedic surgeon
- occupational therapist
- VAS
- sensation assessed
Sensate v insensate salvage groups
- no difference late amputation
- no functional difference
- similar sensory examinations at 24 months
Insensate salvage v insensate amputation
- amputation more likely to use walking aid
- amputation more likely to have difficulty with stairs
Impression
- insensate sole is a poor predictor of eventual function and poor guide to amputation
- a large number have reversible ischaemia or neuropraxia
Outcomes of Reconstruction or Amputation
Bosse et al N Eng J Medicine Dec 2002
Case matched
- functional outcome for amputation or reconstruction the same