LEAP Study

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