Search Results (142)

Background: In Peripheral Artery Disease (PAD), there is an association between risk factors, the location of atherosclerotic lesions, and outcomes. Methods: This is a retrospective single-center analysis of adult PAD patients admitted between 2018 and 2021 with a follow-up until the end of 2023. Lesions were allocated to “suprainguinal”, “infrainguinal-to-popliteal”, “infrapopliteal”, “two of three levels” and “all three levels” categories based on angiogram findings. The primary endpoint at the patient level was amputation-free survival and was major adverse limb events (MALEs) at the limb level. Results: A total of 2067 patients with 2633 affected limbs were analyzed, and 28.8% were female. At first admission, the median age was 68, and the most frequent PAD Fontaine stage was IIb (44.9%). Lesions were suprainguinal in 11.6%, infrainguinal-to-popliteal in 18.3%, infrapopliteal in 11.4%, two levels in 36.0%, and all three levels in 8.3%. Over 1020 days as the median follow-up, amputation-free survival was 67.6%, highest (92.5%) for suprainguinal lesions, and lowest (59.3%) for infrapopliteal lesions. At the patient level, the risk of major amputation or death was highest in infrapopliteal lesions and was equally likely in cases of two or three affected locations and was reduced in infrainguinal-to-popliteal lesions (Hazard Ratio, HR 0.62, 95% CI 0.44–0.87, p = 0.007) and suprainguinal lesions (HR 0.42, 95% CI 0.21–0.79, p = 0.008). At the limb level, compared to lesions in all three locations, the risk of MALEs was reduced in infrainguinal-to-popliteal lesions (HR 0.51, 95% CI 0.27–0.98, p = 0.044) and was equally likely in all other cases. Conclusions: Amputation-free survival was lowest in cases of infrapopliteal lesions or multi-level disease. At the limb level, isolated infrainguinal-to-popliteal lesions were associated with the lowest risk of MALEs. Full article

Background: Although most amputations caused by diabetes and peripheral artery disease (PAD) are preventable, current limb preservation efforts in the United States remain poorly understood. This study aims to identify key barriers and facilitators to limb preservation from the primary care provider (PCP) perspective. We plan to use the insights from this work to promote targeted intervention strategies. Methods: Using a mixed-methods design, an online 5–10 min survey was distributed to Oklahoma primary care providers who could elect to participate further in a semi-structured, audio-recorded interview. Descriptive analysis was used to summarize survey results. Interviews were transcribed and qualitatively analyzed using grounded theory. Donabedian’s structure, process, and outcome framework was used to categorize how each identified barrier and facilitator increases or reduces the risk of limb loss for at-risk patients at the practice level. Finally, we compared and contrasted survey and interview findings. Results: Thirty surveys were completed (approximately 14% response rate), and seven interviews were conducted with PCPs geographically dispersed across Oklahoma. Most clinicians reported in the survey that they see at-risk limbs at least once every 1–2 months (n = 29, 96.7%). Half of clinicians were satisfied or very satisfied with access to vascular surgery (n = 15, 50.0%), interventional specialists (n = 13, 43.3%), and endocrinologists (n = 12, 40.0%). Finally, survey respondents reported that social needs most often affecting their patients with a limb at risk of amputation include income, health education, transportation, and health insurance. Interviews confirmed PCPs frequently see at-risk limbs. We identified thematic barriers to limb preservation that included limited access to specialty care, limited PCP and patient amputation prevention education, and patient social struggles surrounding transportation, finances, and insurance. Patient advocates (community, clinical, or personal), affordable medications, and more time with patients were reported as facilitators in amputation prevention. Conclusions: Oklahoma PCPs frequently see at-risk feet, realize poor access to care, and desire structural change to support excellent preventive care in diabetes and PAD. Limb preservation in Oklahoma is contingent upon shifting from disempowerment to engagement that requires systemic reform, clinical innovation, and community engagement. We identified several intervention strategies, including increasing education for PCPs to empower them to initiate early prevention, improving early identification and preventive therapy for patients at risk for limb loss, and cultivating specialty care access via networking and policy change. Full article

Background: Post-traumatic osteomyelitis (PTO) of the lower extremity is among the most demanding problems in orthoplastic reconstructive surgery. It typically follows open fractures, failed osteosynthesis, or implant infection. Effective management requires coordinated infection control, stable skeletal fixation, and timely vascularized soft-tissue coverage. Methods: We conducted a retrospective case series of 20 consecutive patients with PTO of the lower limb treated between 2021 and 2024 at a tertiary orthoplastic center. All patients underwent radical debridement, culture-directed intravenous antibiotic administration, and soft-tissue reconstruction using local muscle, fasciocutaneous, or free flaps; vascularized bone flaps were used to select nonunion cases. The primary outcomes were flap survival, complications, infection resolution, and limb salvage. Exploratory analyses included descriptive subgroup summaries by flap category. Results: Among 20 patients (15 men, 5 women; mean age 53.6 years), reconstructions included reverse/pedicled sural flaps (n = 9), hemisoleus muscle flaps (n = 7), medial gastrocnemius muscle flaps (n = 2), peroneus brevis muscle flaps (n = 2), and free flaps (n = 6), which comprised anterolateral thigh (ALT), medial femoral condyle (MFC) osteoperiosteal, deep circumflex iliac artery (DCIA) osteocutaneous, and radial forearm free flaps (RFFFs). Single-flap reconstructions were performed in 13 cases, whereas multistage/multiflap strategies were used in 7. Overall flap survival was 90%. Major flap complications comprised partial necrosis in two reverse sural flaps and one complete loss of a reverse sural flap; two patients had minor wound dehiscence. Infection resolved in 18/20 patients (90%; 95% CI ≈ 0.70–0.97). One patient requested below-knee amputation due to persistent nonunion associated with a pathological fracture. At a mean 10-month follow-up, all limb-salvaged patients were ambulatory. Conclusions: Effective reconstruction of PTO is improved by using a patient-specific algorithm that considers the defect location, vascular status, and host comorbidities. Local muscle and fasciocutaneous flaps remain dependable for most defects, with free or vascularized bone flaps reserved for composite or recalcitrant cases. Early referral to high-volume centers, radical debridement, and orthoplastic collaboration are critical for optimizing limb salvage. Our findings should be interpreted in light of the study’s retrospective design and small sample size. Full article

Background and Objectives: The impact of peripheral below-the-knee (BTK) fractional flow reserve (FFR) on long-term clinical outcomes remains unknown. Materials and Methods: We enrolled 40 patients with severe BTK lesions (Rutherford 4–6). FFR (using 40 mg papaverin) and skin perfusion toe pressure (SPTP) by laser Doppler were measured during the index procedure. The primary outcomes were major adverse limb events (MALEs) (defined as reintervention on the index arterial segment or amputation of the index limb) and death during follow-up. Results: The median follow-up was 7 [IQR 4–8] years. After the index procedure, FFR increased significantly (p < 0.001) and post-revascularization SPTP was significantly higher in the FFR ≥ 0.80 group (p = 0.022). Multivariable regressions showed no association between change in FFR (absolute or percentage) and the risk of death (p = 0.39, p = 0.28) or MALEs (p = 0.83, p = 0.29), but both pre- and post-revascularization FFR values could predict MALEs at follow-up (p = 0.018, p = 0.012). Lower SPTP was also associated with the risk of MALEs (p = 0.027). SPTP > 97.8 mmHg was 100% specific for FFR ≥ 0.80. Conclusions: While there is no association between change in FFR and the risk of death or MALEs, lower FFR values either before or after revascularization were associated with higher long-term risk of MALEs. Moreover, a lower SPTP was associated with a higher risk of MALEs. Aiming for approximately 100 mmHg in SPTP represents a non-invasive surrogate of FFR ≥ 0.80. Larger studies are needed to validate the impact of post-revascularization FFR-SPTP-adjacent values on clinical outcomes. Full article

Background: Medial arterial calcification (MAC) is a vascular disorder that affects the arterial media layer. It represents a predictor of major adverse limb events in patients affected by diabetes mellitus (DM). This single-center retrospective observational study investigates whether ultrasound (US) detection of MAC in below-the-knee (BTK) vessels represents a negative predictor of major adverse cardiovascular events (MACE) in asymptomatic patients. Methods: In 2019, 584 patients, referred to the Vascular Surgery Unit for lower limb US, were examined by the same operator, who assessed the presence of BTK MAC. The primary outcome was the rate of MACE during a 5-year follow-up period. The secondary outcomes included the development of peripheral arterial disease (PAD), the overall survival rates, lower limb revascularizations, and major amputations. Results: MAC in BTK vessels was highlighted in 239 patients (MAC+) who exhibited a younger age (p < 0.001), DM (p < 0.001), and chronic kidney disease (CKD) (p = 0.048). The 345 subjects without MAC (MAC−) showed prior myocardial infarction (p < 0.001), stroke (p = 0.034), and smoking habits (p < 0.001). After propensity score matching, the MAC+ group presented a higher risk of MACE (HR: 1.84; CI: 1.01–3.38; p = 0.047) during a median follow-up of 57 months. Age (HR: 1.06; CI: 1.01–1.12) and MAC (HR: 1.22; CI: 1.06–1.57) were independently associated with MACE. New diagnoses of PAD mainly occurred in the MAC− group (p < 0.001). No differences were observed in major amputations, revascularization procedures, or overall survival rates. Conclusions: Ultrasound detection of BTK MAC was associated with the presence of DM and CKD and with a 1.8-fold increased risk of developing a MACE within 5 years in asymptomatic patients. Full article

(1) Background: Comparison of clinical outcomes between patients with moderate-severe aortic valve stenosis and those with mild or no aortic valve stenosis undergoing surgical revascularization for critical limb threating ischemia (CLTI). (2) Methods: Single center retrospective analysis of consecutive patients undergoing surgical lower limb revascularization with femoro-distal bypass for critical ischemia between 2016 and 2022. All patients were evaluated preoperatively by echocardiographic examination and divided into two cohorts: group A with moderate-severe aortic valve stenosis (AVA-cm² < or =1.5 cm²) and group B with mild or absent stenosis (AVA-cm² > 1.5 cm²). Primary outcomes were major limb amputation and mortality between the two groups. The rate of major cardiovascular events (stroke, myocardial infarction, sudden cardiac death) and change in “preoperative functional status” were the secondary outcomes. Descriptive statistics for continuous variables were performed by calculating means, standard deviation (SD) medians, and interquartile range (IQR) while, for categorical variables, frequencies and percentages were performed. Intergroup comparison tests, for continuous variables, were performed by t-test or corresponding nonparametric tests (Mann-Whitney test) while, for categorical variables, Chi-square test was used. Evaluation of cut-offs for the variable AVA-fx-cm², in terms of predictive of outcome outcomes, was calculated by ROC curves. Comparison between clinical and outcome variables was performed using logistic regression models. A total of 316 patients were analyzed and divided in two groups: 50 (16%) patients with moderate or severe aortic valve stenosis (group A) and 266 (84%) with no or mild aortic valve stenosis (AVA > 1.5 cm²). Patients in group A were significantly older than those in group B (78 years vs. 74 years, p value = 0.005); no other significant comorbidity differences were found between the two groups. The mean follow-up was 1178 days (SD 991 days; 2–3869 days). There were no statistically significant differences between group A and group B in terms of major amputation rate (20% vs. 16.5%; p = 0.895) and overall mortality (48.0% vs. 40.6%; p = 0.640). In the total cohort, the statistically significant variables associated with the major amputation were systemic perioperative complication (OR 5.83, 95% CI: 2.36, 14.57, p < 0.001), bypass-related complication within 30 days of surgery (OR 2.74, 95% CI: 1.17, 6.45, p = 0.020), surgical revascularization below the knee (OR 7.72, 95% CI: 1.53, 140.68, p = 0.049), and the presence of a previous cardiovascular event (OR 2.65, 95% CI: 1.14, 6.26, p = 0.024). In patients undergoing surgical revascularization for CLTI, no significant difference in major amputation rate and overall mortality was found between subjects with mild or no aortic valve stenosis and those with moderate/severe stenosis. As expected, overall mortality was higher in older patients with worse functional status. A significantly higher rate of limb amputation was found in those subjects undergoing subgenicular revascularization, early bypass failure, or previous cardiovascular event. Full article

Introduction and Aim: Sarcopenia has emerged as a key prognostic factor in patients with chronic limb-threatening ischemia (CLTI), with potential implications for clinical decision-making. This study aimed to assess the association between sarcopenia and clinical outcomes, mortality, and amputation, using simple, accessible screening tools in a CLTI population. Methods: In this prospective, single-center study conducted between December 2023 and December 2024, 170 patients with CTLI were enrolled. Sarcopenia screening was performed using the SARC-F (strength, assistance in walking, rising from a chair, climbing stairs, falls) questionnaires, handgrip strength measurement, and calf circumference, adjusted for body mass index and sex. The primary outcome was 6-month all-cause mortality and/or major amputation. Results: Sarcopenia was identified in 77 patients (45.3%). Compared to non-sarcopenic individuals, sarcopenic patients were significantly older. They exhibited greater functional impairment, as well as poorer nutritional and muscle status. They also had significantly higher in-hospital mortality (16.9% vs. 3.2%, p = 0.002), 30-day mortality (24.7% vs. 4.3%, p = 0.001), and 6-month mortality (50.6% vs. 15.1%, p = 0.001). Sarcopenia was significantly associated with the primary outcome in univariate analysis (HR: 2.05; 95% CI: 1.31–3.20; p = 0.002) and remained an independent predictor after multivariate adjustment (HR: 1.95; 95% CI: 1.01–3.79; p = 0.048). Conclusions: Sarcopenia is a strong, independent predictor of poor outcome in patients with CLTI. Its detection through simple tools offers an easy and cost-effective strategy to improve risk stratification and guide early intervention through exercise-based therapy. Full article

Background: With increasing pharmacokinetic evidence suggesting the inadequacy of conventional dose intravenous co-amoxiclav (IVCA) 1.2 g Q8H in targeting Enterobacterales, our institution antibiotic guidelines optimised dosing recommendations for diabetic foot infection (DFI) management to 1.2 g Q6H in August 2023. In this study, we aim to evaluate the efficacy and safety of the optimised dose IVCA in DFI treatment. Methods: In this single-centre cohort study, patients ≥ 21 years with DFI, creatinine clearance ≥ 50 mL/min, and weight > 50 kg, who were prescribed IVCA 1.2 g Q8H (standard group (SG)), were compared with those prescribed IVCA 1.2 g Q6H (optimised group (OG)). Patients who were pregnant, immunocompromised, had nosocomial exposure in last 3 months, or received < 72 h of IVCA were excluded. The primary efficacy outcome was clinical deterioration at end of IVCA monotherapy. The secondary efficacy outcomes include 30-day readmission and mortality, empiric escalation of antibiotics, lower limb amputation, and length of hospitalisation. The safety outcomes include hepatotoxicity, renal toxicity, and diarrhoea. Results: There were 189 patients (94 in SG; 95 in OG) included. Patients in SG (31.9%) were twice as likely to experience clinical deterioration compared to OG (16.8%) (odds ratio: 2.31, 95% confidence interval: 1.16–4.62, p < 0.05). There were statistically more patients who had 30-day all-cause mortality in SG (5.3%) compared to OG (0%) (p < 0.05). Furthermore, 30-day readmission due to DFI in SG (26.6%) was higher compared to OG (11.6%) (p < 0.05). Empiric escalation of IV antibiotics was required for 14.9% patients in SG and 6.3% patients in OG (p = 0.06). There was no statistical difference for lower limb amputation (p = 0.72), length of hospitalisation (p = 0.13), and the occurrence of safety outcomes in both groups. Conclusions: This study suggests IVCA 1.2 g Q6H is associated with the decreased likelihood of clinical deterioration and is likely as safe as IVCA 1.2 g Q8H. The optimised dose of IVCA may help reduce the use of broad-spectrum antibiotics due to clinical deterioration. Full article

The present paper investigates the application of convolutional neural networks (CNNs) for the classification of diabetic foot ulcers, using VGG16, VGG19 and MobileNetV2 architectures. The primary objective is to develop and compare deep learning models capable of accurately identifying ulcerated regions in clinical images of diabetic feet, thereby aiding in the prevention and effective treatment of foot ulcers. A comprehensive study was conducted using an annotated dataset of medical images, evaluating the performance of the models in terms of accuracy, precision, recall and F1-score. VGG19 achieved the highest accuracy at 97%, demonstrating superior ability to focus activations on relevant lesion areas in complex images. MobileNetV2, while slightly less accurate, excelled in computational efficiency, making it a suitable choice for mobile devices and environments with hardware constraints. The study also highlights the limitations of each architecture, such as increased risk of overfitting in deeper models and the lower capability of MobileNetV2 to capture fine clinical details. These findings suggest that CNNs hold significant potential in computer-aided clinical diagnosis, particularly in the early and precise detection of diabetic foot ulcers, where timely intervention is crucial to prevent amputations. Full article

Background: Diabetic foot disease is a public health problem. The challenges of its management lie in the complexity of wound healing and, in particular, the high rate of lesion recurrence. Objectives: The primary objective of the study was to evaluate whether optimized post-healing follow-up by a multidisciplinary team can reduce the recurrence rate of foot ulcers in people living with diabetes. The secondary objectives were to assess patient needs in terms of hospitalization for recurrence, the number of amputations, pedicure care, and the use of adapted footwear. Participants: The study included 129 patients with diabetes presenting a healed foot ulcer. A total of 38 patients underwent an annual post-healing follow-up visit with a multidisciplinary team (optimized follow-up), while 91 had a visit every 2 years (minimum follow-up). Results: Of the 38 patients with optimal follow-up, 8 presented a wound recurrence (21.1%) compared with 38 out of 91 patients (41.8%) receiving minimum follow-up. The recurrence rate decreased significantly between the two groups (p < 0.05). The use of adapted shoes was also significantly better in the group with optimized follow-up (p = 0.02). Conclusions: Regular post-healing follow-up with a multidisciplinary team seems to be a contributing factor to reducing the recurrence of diabetic foot ulcers among people living with diabetes. Full article

Background/Objectives: The aim of this study is to describe the characteristics of a cohort of patients who underwent surgery for septic non-union of the lower extremities. Methods: We analyzed clinical data from 74 patients affected by septic non-union of long bones in the lower extremities, treated with the Ilizarov method between January 2006 and December 2021. The primary objective of our study was to describe the time from surgery to bone union. Results: Patients had undergone a median of three previous surgical interventions, had an average bone defect of 5.4 cm, with 43.4% of patients having a Non-Union Scoring System (NUSS) > 75 points, and 46.5% of patients having been considered candidates for limb amputation in other centers. Bone union was achieved in 73 patients (98.65%), while infection resolution was achieved in 68 patients (91.89%). In 63 patients (85.13%), healing was obtained with one surgical procedure only. Only 11 re-interventions were necessary after frame removal (14.86%): 10 were due to re-fractures (13.51%) and 1 to an infection recurrence, which resulted in an amputation (1.35%). At a time of 6.01 ± 3.9 years follow-up, the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system indicated excellent or good outcomes in 97.3% for the bone subscale and in 89.2% for the functional subscale. The Patient Global Impression of Change (PGIC) showed that 96.8% of patients were “very much improved” or “much improved”. Patients who have suffered a more recent trauma or fewer previous surgeries achieved a better outcome. Conclusions: Despite some limitations, this study shows that treatment of septic non-unions using the Ilizarov method is both highly effective in bone and infection healing and results in a satisfactory functional outcome. The results observed in our cohort suggest that the Ilizarov method could be critically re-evaluated as a primary treatment option for these challenging cases. The clinical relevance of these findings lies in their potential to significantly alter the current treatment paradigm, by questioning the need for biologic adjuncts and local antibiotics, thereby reducing healthcare costs. Full article

Background: Cutaneous squamous cell carcinoma (SCC) is the most common primary malignant tumor of the hand, and its aggressive nature can lead to significant morbidity, particularly when affecting critical structures like the thumb. SCC in this location may arise in the periungual area or the pulp and frequently presents with non-specific symptoms such as swelling, nail deformity, or discharge, features that closely mimic common benign conditions. Methods: A retrospective study analyzed patients with neglected or misdiagnosed SCC of the thumb treated at the Hand and Microsurgery Unit of the Jewish Hospital, Rome, between 2015 and 2025. Patient demographics, duration from symptom onset to diagnosis, initial misdiagnoses, and imaging findings (X-rays, MRI, CT scans, lymph node sonography) were reviewed. Surgical interventions, histopathological grading, and postoperative management were documented, with long-term follow-up focusing on disease progression and patient survival. Results: Sixteen patients were included in the study. The mean age at surgery was 73.6 years (range: 55–93 years), with a mean delay of 8.2 months from symptom onset to diagnosis in 87.5% of cases. Initial misdiagnoses included verruca vulgaris, onychomycosis, paronychia, and osteomyelitis. Imaging consistently revealed soft tissue involvement, bony invasion, and occasional metastasis. Surgical approaches ranged from wide resection to amputation, with thumb reconstruction in selected cases and hand amputation in severe presentations. Long-term follow-up (mean 4.6 years) showed high morbidity, a reduction in hand function and QoL, and a 50% mortality rate, with two cases due to metastatic disease (12.5%). Conclusions: Thumb SCC presents diagnostic and therapeutic challenges, exacerbated by late diagnosis and initial misdiagnoses. Multidisciplinary management involving early recognition, comprehensive imaging, appropriate surgical interventions, and vigilant follow-up is crucial for optimizing outcomes. Full article

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

Aims: Extremity sarcomas (ES) are rare, aggressive malignancies requiring complex surgical decisions. While limb-salvage surgery (LSS) is the preferred treatment to preserve functionality, local disease progression can necessitate secondary amputation. The oncological outcomes of secondary amputation compared to primary amputation remain uncertain, particularly with long-term follow-up. This study aimed to compare overall survival (OS), metastasis-free survival (MFS), local recurrence-free survival (LRFS), and postoperative complications between ES patients undergoing primary amputation (V1) and those requiring secondary amputation after failing LSS (V2), with a minimum follow-up of five years. Methods: A retrospective review was conducted at a national sarcoma center, including 71 patients treated between 2007 and 2017. Patients were categorized into V1 (n = 28) and V2 (n = 43) groups. Clinical and oncological data were collected from medical records and imaging, including tumor stage, surgical margins, and postoperative complications. All patients were followed up for a minimum of five years or until death. Kaplan–Meier survival analysis was performed to evaluate OS, MFS, and LRFS. Results: OS was 25% in the V1 group and 39.5% in the V2 group (p = 0.6). MFS (10.5 months, p = 0.2) and LRFS (27.4 vs. 34.4 months, p = 0.6) were comparable between groups. Postoperative complications occurred in 34.9% (V1) and 32.1% (V2) of patients, with infections being the most common complication. Patients with complications exhibited shorter MFS (p = 0.029). Negative surgical margins were achieved at 96.4% (V1) and 97.6% (V2). Conclusions: Secondary amputation following failing LSS demonstrates similar oncological outcomes to primary amputation, even with a minimum follow-up of five years. These findings support LSS as the preferred initial approach for ES patients. Postoperative complications associated with reduced MFS underscore the need for rigorous postoperative protocols. A multidisciplinary approach remains essential for optimizing long-term outcomes. Full article

Background: This study examined the incidence of acute complications within the first year following combat-related lower extremity injuries in United States (U.S.) Service members (SMs). The research compared outcomes between primary amputation (PA), limb salvage (LS), and non-threatening limb trauma (NTLT) groups, and conducted a subgroup analysis within the LS group, differentiating between SM who underwent a secondary amputation (LS-SA) and those who did not (LS-NA). Methods: A retrospective analysis of combat-related lower extremity injuries sustained between January 2001 and October 2015 was performed using data from the Military Health System Medical Data Repository. Chi-square tests and adjusted logistic regression analysis were used to compare complication frequencies by injury severity. Results: The analysis of the 4275 SM revealed that 21% had undergone PA, 47% LS (with 13% experiencing LS-SA and 87% LS-NA), and NTLT was observed in 32% of cases. The PA group exhibited higher rates of most acute complications compared to other groups, with three exceptions—i.e., non-union fractures, compartment syndrome, and orthopedic device complications were more prevalent in the LS group than the PA group. The LS-SA group had higher complication rates than the LS-NA group for most complications. Notably, the PA group was associated with the highest rates of post-hemorrhagic anemia and heterotopic ossification, while the LS-SA group exhibited the highest rates of osteomyelitis, non-union fractures, non-healing wounds, and compartment syndrome. Conclusions: Individuals with amputation (PA or LS-SA) were more likely to experience acute complications compared to their counterparts (PA vs. LS and NTLT; LS-SA vs. LS-NA), with the exception of non-union fractures, which were more frequent in the LS group than the PA group. These findings highlight the need for close monitoring and targeted interventions to address post-surgical complications in Service members with limb salvage. Full article