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- Talk
- 23/09/2021
- UK
Free Paper Session: Limb salvage surgery: Progress since the Lower Extremity Assessment Project (LEAP) – A Systematic Review of the Literature
Description
The presentation led by Louise McMenemy outlines a systematic review concerning lower extremity trauma and the associated outcomes of limb salvage versus amputation following high energy lower extremity trauma (HELET). It begins with a summary of the LEAP study, highlighting its findings that indicated no significant difference in functional outcomes between amputation and limb salvage after two and seven years, despite both groups performing worse than the general population.
The review particularly emphasizes advancements in limb salvage techniques, prosthetic design, and rehabilitation since the LEAP study, and notably includes military patients in the analysis, which LEAP had excluded. The aim was to explore the literature published since 2005 to determine whether outcomes had improved over the last two decades, particularly due to the advanced prosthetic options available to military personnel.
A thorough literature search adhering to PRISMA guidelines was conducted, resulting in 39 studies from an initial pool of 1,378 papers, focusing on research published between 2006 and 2019. The findings revealed that, unlike civilians, military amputees benefited from superior functional outcomes and improved patient-reported outcomes following amputation, supporting the hypothesis that military advancements contribute positively to recovery.
However, the study found that overall, patient-reported outcomes for both military and civilian cohorts continued to fall below population norms, with significant pain issues reported in both groups. The limb salvage failure rates were notably higher in the military cohort compared to civilians, attributed to the nature of high-energy blast injuries predominantly seen in military settings.
The conclusion posits that while outcomes for civilian patients have not changed since LEAP, military amputees are achieving better functional results. The need for long-term follow-up for amputees was underscored, as well as a call to enhance rehabilitation pathways for limb salvage patients to optimize their outcomes.