Limb Salvage Versus Amputation: A Review of Variables Influencing the Assessment and Decision-Making in Complex Limb Fracture Management

Complex limb injuries are combination injuries that involve all components of a limb's tissue, such as skin, bone with its surrounding soft tissue cover, and neurovascular elements. Complex limb trauma often has a background of a significant mechanism of injuries such as high-velocity road traffic accidents, ballistic injuries, industrial accidents, and other major mechanisms of injuries which involve high amounts of energy transfer through these tissue layers. These injuries pose a major challenge to trauma and orthopaedic surgeons. This article aims to provide a comprehensive, up-to-date literature review on assessing complex limb injuries and their variables that affect decision-making and outcomes in both limb salvage and amputation. The preservation of a competent blood supply up and distal to an injury is of vital importance for any limb to survive. In a haemodynamically stable patient, it is pivotal to assess the status of peripheral circulation by examination of the distal pulses, skin colour, peripheral warmth and capillary refill time. An early and prompt multidisciplinary team approach with effective and timely input from relevant specialities while prioritising saving life to limb salvage should be a vital aspect of the initial assessment of patients with complex limb injuries. Although salvage versus amputation could be a tough decision, there are relevant scoring systems that can be used as guiding tools in the decision-making process. Although evidence suggests that amputation may result in favourable outcomes, the final decision should be based on the surgeon's experience, the extent of soft tissue damage and the patient and/or their family's wishes after giving them an opportunity and time to process their thoughts to take the best decision in their best interest and thereby give informed and written consent. A prompt early intervention while considering the above-mentioned factors to achieve adequate soft tissue cover is the key to an optimal and functional outcome.