Amputation versus limb salvage.

The decision to attempt salvage or to amputate a severely injured leg in among the most difficult that the orthopaedist must face. Even surgeons with tremendous trauma experience cannot agree on standard course of action. In the face of such injuries, physician consultation regarding the treatment decision, including all of those members of the team that are needed for a successful salvage, is necessary. In the best circumstances, the trauma surgeon, vascular surgeon, orthopaedist, and a soft-tissue specialist are all involved. From a psychological perspective, the timing of an amputation is important. Although each patient's case is unique, immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. It is imperative that the surgeon have a detailed discussion with the patient and the family whenever possible before making the decisions. Scoring systems are of some help in estimating the chances of a successful salvage. However, the ultimate decision to amputate or attempt salvage is based on such patient factors as preinjury function and social situation, and of associated injuries, surgeon experience, available resources, projected physical abilities, and the patient's projected physical requirements. These decisions are difficult and tax the judgment and emotions of the patient, family, and physician.