A Look at the Course and Management of Non-Traumatic Upper Extremity Amputation

Abstract

Objectives Amputation is a major source of morbidity and mortality. Non-traumatic amputations of the upper extremity are less common, and less well-characterized, than the lower extremity. We hypothesize that upper extremity amputations are often associated with multiple returns to the operating room. Methods Twenty-five patients were identified that underwent primary or revision ray or phalangeal amputations for vascular/infectious indications. Chart review was utilized to gather information on additional amputations and demographic information. These groups were compared via chi-squared analysis assuming equal distributions of operations would be present between groups. Results Of the patients with infectious and/or vascular amputations, 56% had a subsequent amputation. Additionally, 23 irrigation and debridement\’s (I and D) were performed before resorting to amputation with 6 patients requiring multiple I and Ds. Post-amputation, 3 patients required I and D, 7 revision amputations at higher levels, 8 amputations of additional ipsilateral digits, and 4 amputations of contralateral digits were performed. After initial amputation, there is a 76% chance of undergoing an additional operation and/or amputation of the upper extremity. A subgroup of these patients with diabetes showed statistically significant increases in ipsilateral amputations following initial amputation. Conclusions Our study shows that patients undergoing digit amputation for nontraumatic indications may require additional upper extremity operations following initial amputation. Subsequent revision amputation at a higher level is common and suggests that more aggressive early amputation may be warranted in these patients. Specifically, diabetic patients are at significantly increased risk of requiring additional digit amputations and may benefit from more aggressive initial surgery at time of presentation.