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Lower extremity amputation

Author
Venkat Kalapatapu, MD
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Lower extremity amputation is performed to remove ischemic, infected, necrotic tissue or locally unresectable tumor, and, at times, is a life-saving procedure. Peripheral artery disease, alone or in combination with diabetes mellitus, contributes more than half of all amputations; trauma is the second leading cause. The second Trans-Atlantic Inter-Society Consensus Working group (TASC II) documented an incidence of major amputations due to peripheral artery disease ranging from 12 to 50 per 100,000 individuals per year [1]. The aging population is expected to increase this number by 50 percent in the next 15 years [2].

Factors that predict the need for lower extremity amputation in patients with extremity ischemia include tissue loss, end-stage renal disease, poor functional status, and diabetes mellitus. Patients with diabetes have a 10-fold increased risk for lower extremity amputation compared with those who do not have diabetes. Amputees with diabetes are more likely to be severely disabled, to experience their initial amputation at a younger age, progress to higher-level amputations, and die at a younger age compared with patients without diabetes [3].

The indications and techniques for lower extremity amputation, postoperative care, complications, and outcomes are reviewed here. Techniques for performing lower extremity amputation are discussed elsewhere. (See "Techniques for lower extremity amputation".)

TERMINOLOGY

Major amputation refers to any amputation performed above the level of the ankle. Foot amputations are those at or below the ankle. (See 'Amputation techniques' below.)

Amputation performed without an attempt at limb salvage (eg, revascularization, bony repair, soft tissue coverage) is termed primary amputation, whereas amputation following a failed attempt at revascularization is termed secondary amputation. Traumatic amputation refers to limb loss that occurs in the field at the time of injury.

                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 21 00:00:00 GMT+00:00 2016.
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