A prospective study of lower limb amputations - Wheeless' Textbook of Orthopaedics

Barber GG. McPhail NV. Scobie TK. Brennan MC. Ellis CC. Canadian Journal of Surgery. 26(4):339-41, 1983 Jul. Most leg amputations are performed for vascular disease. A mortality of 30% was associated with above-knee amputations in this study. Healing by primary intention took place in 59% of patients, 31% had delayed healing and 10% required a revision. Only 10% of above-knee amputees used a prosthesis and 48% required total bed care. Below-knee amputations in which a rigid dressing was used had slightly better healing than when soft dressings were used but the difference was not significant. The overall reamputation rate was 15%, the mortality was 7.2% and 57% were fully ambulatory with a prosthesis. Amputation at either the transmetatarsal or digital level was carried out in 25% and 80% healed. The mortality was 11%. Clinical observation is still the best determinant of the level of amputation; below-knee amputation should be strived for in every patient who is a candidate for rehabilitation. Use of a rigid dressing is recommended.