Major Lower Extremity Amputation

Abstract

Major lower extremity amputation is still a commonly performed operation, even in hospitals that emphasize aggressive revascularization for limb salvage. Although some reports¹ document decreasing major amputation rates during the past decade, possibly as a result of increased aggressiveness in revascularization and endovascular intervention, other reports² do not demonstrate this relationship in patients with peripheral vascular disease. Major amputation is a commonly performed procedure that is indicated in patients with failed attempts at revascularization, comorbidity or anatomic factors precluding revascularization efforts, and extensive tissue loss or infection. An underlying goal in the care of the patient who requires amputation is to retain the knee joint if possible given its contribution to more efficient ambulation with a prosthesis, requiring less energy expenditure.³ Multiple studies^4,5 have documented the increased rehabilitation rate in below-knee amputation (BKA) vs above-knee amputation (AKA) patients, with more than 65% of BKA patients ambulating with prostheses. In contrast, less than one third of AKA patients are likely to rehabilitate with the use of a prosthesis.⁶ Likely due to the significant comorbidities of patients undergoing amputation for ischemic disease, perioperative mortality rates range from 0.9% to 14.1% for BKA patients and are significantly worse for AKA patients at 2.8% to 35%.^7-10