Outcome after peripheral vascular injuries in multiple trauma patients

The therapeutic concept of limb salvage or immediate amputation is controversial in patients with multiple trauma. Sixty-three multiple trauma patients (injury severity score ISS >18 patients) with blunt arterial injuries were investigated. Twenty-seven had injuries of the tipper limb and 36 patients of the lower limb. In 33 cases a limb salvage procedure was performed (group I), while in 30 cases the limb was amputated (group II). Neither group showed a significant difference in age (I: 33+/-3, II: 30+/-3 years), ISS (I: 30+/-2, II: 29+/-2 patients), time of ischemia (I: 238+/-30, II: 203+/-20 min) ICU stay (I: 18+/-4, II: 19+/-4 days). Lethality and morbidity were slightly increased in group I (death: I: n=8; II: n=4; MOF: I: n=5; II: n=3; Sepsis: I: n=11, II: n=4). No differences were found in the incidence of local infections (I: n=12, II: n=10). Secondary amputations were performed in 7 patients after 12+/-2 days (range 3-40; median: 5 days). We conclude that limb salvage did not increase the risk for severe complications. Lethality and morbidity were related to the severity of the injury. To prevent complications, secondary amputations had to be performed early.