Amputation oder Rekonstruktion - Extremitätenerhalt in Grenzsituationen

We examined all patients that underwent amputation or reconstructive surgery for endangered limbs due to trauma or other reasons (ischemia, infection) between 1.1.1980 and 31.12.2005 at the Department of Trauma, Hand and Reconstructive Surgery of Ulm University. We analyzed therapeutic and diagnostic strategies as well as the development of frequenzy of ablations or re-constructive surgery over the years. 2200 amputations were performed in the period of regard, 745 of upper and 1455 of lower limbs. In the same time 1783 successful operations in order to save extremities were performed, 860 in the upper and 923 in the lower limb. 46 patients (2%) had a “MESS” (mangled extremity severity score) of six or more points indicating the need for amputation, thus these limbs were saved. 1450 ablations were done between 1980 and 1990, but only 750 from 1991 until the end of 2005. 60% of the operations in the lower and 83% of those in upper limbs were “minor” ablations (toes, finger, forefoot) whileas 17% of amputations in the upper and 40% in the lower extremities were “major” resections up to complete leg and arm. Using single typical cases treated in our institution, we discuss indication and contraindication for saving of limbs under critical conditions. In addition to surgical and medical aspects, psychosocial and familiar surroundings of the patients may not be neglected when deciding if a limb can be saved or not.