Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons | Journal CME Article-Journal CME Article: Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons Article

Journal CME Article: Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons Article

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The document is a comprehensive review on lower extremity (LE) amputations, a practice dating back to ancient times with significant evolution in techniques and outcomes. Historically, amputations were the primary solution for severe limb injuries like open fractures due to limited reconstructive options. The development of anesthesia and antisepsis, along with recent advancements in vascular repair and prosthetics, have shifted the focus toward limb salvage while making amputation a considered decision rather than a default.<br /><br />Amputations still occur, typically due to peripheral vascular disease, trauma, and cancer. The emphasis is on assessing whether limb salvage or amputation offers better outcomes, factoring in functional status, and a patient's personal and medical context. Modern trends and innovations have elevated the role of amputation in complex reconstructive strategies, particularly in cases where limb salvage might result in a nonfunctional or painful limb hence delaying rehabilitation.<br /><br />Major procedures like transfemoral (above-knee) and transtibial (below-knee) amputations are discussed. Preservation of maximum limb length is emphasized due to its correlation with energy efficiency in movement and patient quality of life. Additionally, innovative surgical and nonsurgical methods are explored to manage residual limbs and enhance functionality, such as targeted muscle reinnervation and regenerative peripheral nerve constructs.<br /><br />Prosthetic technology, including osseointegration and myoelectric devices, continues to evolve, allowing for enhanced control and comfort, though accessibility remains a challenge due to cost. Comprehensive postoperative rehabilitation protocols focus on maximizing patient autonomy and quality of life, incorporating multidisciplinary care and advanced wound care strategies.<br /><br />Overall, the document highlights the vital role of plastic surgeons in both limb salvage and amputation processes, reflecting the nuanced, patient-centered approach required in modern practice and the importance of incorporating emerging technologies to improve patient outcomes in limb reconstruction.

Keywords

lower extremity amputations

limb salvage

vascular repair

prosthetics

transfemoral amputation

transtibial amputation

targeted muscle reinnervation

osseointegration

myoelectric devices

postoperative rehabilitation