A 37 yr old male brought to emergency room late after road traffic accident . On examination the capillary refilling time is delayed in the left lower limb . All are indications for amputation in this patient, except?
Causes of Amputations 'three Ds': (1) Dead, (2) Dangerous (3) Damned nuisance. Dead (or dying) Peripheral vascular disease accounts for almost 90% of all amputations. Other causes of limb death are Severe trauma, burns and frostbite. Dangerous disorders are malignant tumours, potentially lethal sepsis (Gas Gangrene) and crush injury. Damned nuisance: In some cases retaining the limb may be worse than having no limb at all. This may be because of: (1) pain; (2) gross malformation; (3) recurrent sepsis or (4) severe loss of function. Transcutaneous Oxygen Tension (TcPO2)values > 40 mmHg are indicative of healing whereas values < 20 mmHg are indicative of non-healing and impending limb loss. For values between20- 40 mmHg, the clinician needs to consider co-morbidities like vascular disease, diabetes etc and the patient's nutritional status before considering amputation. Ankle-brachial Index (ABI) > 0.9 indicates absence of vascular injury and values < 0.45 indicate severe injury.
Transcutaneous Oxygen Tension - 40mmHg
Severe Peripheral Vascular disease
Ankle-Brachial Index < 0.45
Fulminant Gas Gangrene
Amputations and Spos Injury