Logo for the Journal of Rehab R and D

Volume 46 Number 3, 2009
   Pages 385 — 394

Abstract – Early delayed amputation: A paradigm shift in the limb-salvage time line for patients with major upper-limb injury

Todd E. Burdette, MD;1* Sarah A. Long, BA;2 Oscar Ho, MD;1 Chris Demas, MD;1 John-Erik Bell, MD;3 Joseph M. Rosen, MD1

1Department of Surgery, Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Thayer School of Engineering, Dartmouth College, Hanover, NH; 3Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Abstract — Patients with major injuries to the upper limbs sometimes fail to achieve successful limb salvage. During the attempt to fashion a functional limb, multiple painful procedures may be ventured. Despite the best efforts of surgeons and therapists, a nonfunctioning or painful upper limb may remain in place for many months or years before late delayed amputation and progression to productive rehabilitation occur. We present three patient cases that illustrate failed upper-limb salvage. In each case, patients expressed a desire for amputation at 6 months after their injury. To reduce the pain and suffering that patients with failed limb salvage endure, we propose a paradigm shift in the limb-salvage time line. We suggest that patients be evaluated for early delayed amputation 6 months after their injury.

Key words: amputation, limb salvage, limb-salvage score, pain, phantom pain, prosthesis, rehabilitation, upper extremity, upper limb, therapy.

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