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Traumatic and Trauma-Related Amputations: Part I: General Principles and Lower-Extremity Amputations

Tintle, LT Scott M. MD; Keeling, CDR John J. MD; Shawen, LTC Scott B. MD; Forsberg, LCDR Jonathan A. MD; Potter, MAJ Benjamin K. MD

Journal of Bone & Joint Surgery - American Volume: 1 December 2010 - Volume 92 - Issue 17 - p 2852–2868
doi: 10.2106/JBJS.J.00257
Current Concepts Review
Supplementary Content

Deliberate attention to the management of soft tissue is imperative when performing an amputation. Identification and proper management of the nerves accompanied by the performance of a stable myodesis and ensuring robust soft-tissue coverage are measures that will improve patient outcomes.

Limb length should be preserved when practicable; however, length preservation at the expense of creating a nonhealing or painful residual limb with poor soft-tissue coverage is contraindicated.

While a large proportion of individuals with a trauma-related amputation remain severely disabled, a chronically painful residual limb is not inevitable and late revision amputations to improve soft-tissue coverage, stabilize the soft tissues (revision myodesis), or remove symptomatic neuromas can dramatically improve patient outcomes.

Psychosocial issues may dramatically affect the outcomes after trauma-related amputations. A multidisciplinary team should be consulted or created to address the multiple complex physical, mental, and psychosocial issues facing patients with a recent amputation.

1Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307. E-mail address for B.K. Potter:

2Department of Orthopaedic Surgery, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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