1. INTRODUCTION METHODS RESULTS DISCUSSION Sam Simmonds prize 17 th May,2013 Sohail Yousaf Will Kieffer Benedict Rogers Iain McFadyen David Ricketts Management of traumatic amputations at BSUH

2. INTRODUCTION METHODS RESULTS DISCUSSION Introduction Trauma related amputations, pre-hospital & in hospital, represent the most severe limb injuries. The evidence base relatively poor especially in civilian practice.

3. INTRODUCTION METHODS RESULTS DISCUSSION Objectives Civilian patients who underwent amputations for unsalvageable limb injuries. treatment caseload resource utilization outcome Setting: UK major trauma centre

4. INTRODUCTION METHODS RESULTS DISCUSSION Methods Sept 2010 – Feb 2013 Retrospective case analysis Local trauma database TARN data

5. INTRODUCTION METHODS RESULTS DISCUSSION Study design Inclusion criteria: trauma-related primary limb amputation. Exclusion criteria: peripheral vascular disease as primary complaint.

6. INTRODUCTION METHODS RESULTS DISCUSSION Results Amputations n=23 Combined Upper & Lower n=1 Bilateral n=0 Unilateral n=18 Bilateral n=1 Unilateral n=3 Lower Extremity n=18 Upper Extremity n=5

7. INTRODUCTION METHODS RESULTS DISCUSSION Total amputations

8. INTRODUCTION METHODS RESULTS DISCUSSION Patient demographics Age (years) mean, (Range)49.7 (25-87) Age >55years38.1% Male71.4% ISS Mean (Range)21.3 (9-50) Bilateral Amputation9.5% Extremity Vascular Injury52.4% Primary Traumatic Amputation4.8%

9. INTRODUCTION METHODS RESULTS DISCUSSION Mechanism of Injury

10. INTRODUCTION METHODS RESULTS DISCUSSION Caseload and resource evaluation Total Number of Theatre Episodes (All Patients) 67 Mean No of Theatre Episodes Per Patient 3.2 (Range 1-6) Mean Length of Stay Post- amputation (days) 38.7 Requirement of rehabilitation66.7%

11. INTRODUCTION METHODS RESULTS DISCUSSION Surgical procedures Attempted Vascular Reconstruction/Repair 19.0% Plastic Surgical Involvement Intra-op 52.4% Skin Graft/Flap Cover47.6% Used of VAC Dressing42.9%

12. INTRODUCTION METHODS RESULTS DISCUSSION Complications Pain/Phantom Pain4 (19.0%) Wound Infection6 (28.6%) Shortening1 (4.8%) Other2 (9.5%)

13. INTRODUCTION METHODS RESULTS DISCUSSION Discussion Largest single centre UK civilian study regarding traumatic amputation. Small proportion of overall caseload, Substantial resource use: before and after discharge, High complication rate.

14. INTRODUCTION METHODS RESULTS DISCUSSION Discussion Injury topography Non-blast injuries more common in civilian practice. Less soft tissue penetration Earlier reconstruction? Blast injuries Significant tissue penetration by foreign material necessitate multiple radical tissue debridements

15. INTRODUCTION METHODS RESULTS DISCUSSION Conclusion differing clinical protocols applicable for civilian vs military trauma-related amputations ? centralised care important to enhance the outcomes. BSUH now maintains a prospective dataset

16. INTRODUCTION METHODS RESULTS DISCUSSION Further information, please contact: Benedict Rogers Orthopaedic Surgeon, BSUH Benedict.rogers@bsuh.nhs.uk Questions