Primary amputation for open fractures
A mangled extremity is a life-threatening injury. Some extremity injuries are so severe that amputation is a safer and more humane option than attempted limb preservation. Injudicious efforts at salvage may be doomed to failure, with the risk of life-threatening complications, particularly infection.
The decision whether to amputate, or to try to save, a severely injured limb is one of the most controversial in trauma surgery. The patient’s physical (and emotional) ability to tolerate injury and prolonged, extensive treatment must be taken into account.
The level of surgical resources at the disposal of the treating surgeon will also influence the choice.
Limb salvage usually requires multiple operations, prolonged hospitalizations, and frequently results in serious complications, ending with a painful and dysfunctional extremity. It was often said by Prof. Sig Hansen that after 2 years of such a program, if the limb was not definitively rehabilitated, the patient would be likely to be “depressed, drug addicted, destitute and divorced!”