Limb-salvage surgery in trauma leg injuries. Does it offer patients better quality of life and functional capacity than amputation?

Background: The decision to salvage or amputate the injured limb has generated much controversy in Literature, with studies to support advantages of each approach. All scoring systems have proved unreliable in predicting the need for amputation or salvage. ‘Making decision' and 'timing' can be difficult even for experts.Objectives: Obviously, it is to avoid amputation of a limb which could be saved, as well as not always trying the revascularization. This is the challenging problem. In our opinion, the issue is not to perform revascularization just because it is technically feasible, but when it should be performed.The purpose of this study is clarify some decisions about management of severely injured legs. Methods: We reviewed the Literature and analized our clinical experience of 89 cases of high-energy trauma of lower limbs (Gustilo, grade III a,b.c), with extensive damage of soft and deep tissues, from 2004 to 2012. All of them were ischemic limbs with high risk of amputation. To evaluate the results we analyzed: length of hospital stay, total rehabilitation time, cost, clinical outcomes, failure rate for limb salvage, factors associated with poor outcome, function and quality of life, return to work, and patient choices. Discussion: To be considered valid, absolute results of this kind of research should be made considering the welfare relating to the capabilities of Health Services and benefits in individual countries. The outcomes may have been influenced by the expertise of physicians and other caregivers.When it’s impossible to obtain the anatomical and functional recovery after limbs’ complex trauma, the amputation still remain the first choice. Recently new technological frontiers in surgery connected with regenerative medicine, new treatment of post traumatic lesions, such as wound care and ‘loss of substance’, have been highlighted in Literature. Conclusions: The introduction of autologous progenitor integrated biomaterials and biotechnology in order to stimulate tissues regeneration made possible avoiding limb amputation revascularizing and obtain a complete and faster healing. A scale which takes into account most of the criteria highlighted it is required, clinical before and social then. We reiterate the difficulty to attribute universal criteria considering the different realities of National Health Systems. The presence of a team dedicated to trauma is very important to assess immediately the possibilities and difficulty elements of the entire surgical procedure and rehabilitation.The limb functional recovery achieved by the interven