Abstract
BackgroundIn the past decades, surgical management of limb injuries in high-resource settings has improved. The possibility of limb salvage has increased. It is not known whether similar changes have transpired in resource-scarce conflict settings.MethodsRetrospective cohort study using routinely collected patient data from the International Committee of the Red Cross hospitals in Pakistan was conducted. Consecutive data from 2009 to 2012 (535 patients) and randomly selected data from 1992 to 1995 (463 patients) were used. Only patients with weapon-related limb injuries were included. Differences in surgical procedures were assessed with logistic regression to adjust for confounding factors.ResultsLess injuries were related to mines in 2009–2012 than in 1992–1995 (3.7% vs. 20.3%, p < 0.0001), but injuries from bombs, shells and fragments were more frequent (38.5% vs. 19.4%, p < 0.0001) as were injuries with only a small degree of tissue damage (42.0% vs. 31.1%, p = 0.0004). In the logistic regression, the time period did not affect the risk of amputation, debridement, length of hospital stay or in-hospital mortality. The use of external fixation (OR 0.56, 95% CI 0.33–0.96, p = 0.04), split skin grafts (OR 0.31, 95% CI 0.21–0.45, p < 0.0001) and blood transfusion (OR 0.43, 95% CI 0.28–0.66, p = 0.0001) was less frequent in 2009–2012.ConclusionIn this resource-scarce conflict setting, the risk of amputation appears unchanged over time, while the use of external fixation and split skin grafts was less common in 2009–2012 than in 1992–1995. These results contrast with the improved limb salvage results seen in high-resource settings. It likely reflects the challenges of providing advanced limb-preserving techniques in a resource-scarce setting.
Highlights
Limb injuries account for a majority (50–75%) of survivable injuries in conflicts
The time period did not affect the risk of amputation, debridement, length of hospital stay or in-hospital mortality
The use of external fixation, split skin grafts and blood transfusion was less frequent in 2009–2012
Summary
Limb injuries account for a majority (50–75%) of survivable injuries in conflicts. Between 25 and 33% are combined with fractures, and the lower limbs are most commonly affected [1,2,3,4,5]. Among Medicare patients, in the USA, a 45% decrease of lower limb amputations for all causes was observed between 1996 and 2011 [15] It remains unclear whether similar improvements have been achieved in conflict-affected low- and middle-resource settings where constraints, such as logistical challenges and security issues, may limit implementations of advances in treatment practices [16]. These constraints in the delivery of and access to surgical care emphasize the importance of understanding what surgical resources are needed in a given context. It is not known whether similar changes have transpired in resource-scarce conflict settings
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
