Daniel J. Scott MD, Adam Stannard MRCS, Zachary M. Arthurs MD, Diane L. Lynd RN, Howard M. Monroe PhD, April C. Ames-Chase RN, William D. Clouse MD, Todd E. Rasmussen MD
San Antonio Military Medical Center, Ft. Sam Houston, TX.
OBJECTIVES: Modern studies on wartime vascular trauma have previously focused on management strategies and early results with no characterization of enduring functional limb salvage or its relation to quality of life. The objective of this study is to describe long-term, patient-based outcomes following extremity vascular injury.
METHODS: The Joint Theater Trauma Registry was queried for U.S. troops with extremity vascular injury. Data from the time of injury was recorded and, in a prospective manner, the Short Form 36 (SF-36) was administered. Primary end-points were amputation-free survival and quality of life measures.
RESULTS: One-hundred eighty-nine (age 27.1±6.6 years) patients completed surveys. Injury Severity and Mangled Extremity Severity Scores were 15.24±8.7 and 5.65±1.4, respectively. Amputation-free survival was 86% at 61±22 months. SF-36 Physical and Mental Component Scores in the overall cohort were 43.3±9.3 and 46.6±12.4, respectively. Compared to limb salvage, secondary amputation had no effect on mental component outcomes but did result in lower Physical Functioning (37.4±11, p<0.05) and Physical Component Summary scores (40.5±9, p=0.09). Additionally, age greater than 40 years or the presence of chronic pain or depression were associated with poor physical and mental component outcomes (p<0.05). Conversely, favorable employment status and a higher educational background were associated with improved outcomes (p<0.05).
CONCLUSIONS: This study characterizes long-term, patient-based outcomes following wartime extremity vascular injury. Despite a laudable amputation rate, a lasting burden of limb salvage is present which limits quality of life years after injury. Additional study is needed to identify management and recovery strategies that will improve post-injury quality of life.
AUTHOR DISCLOSURES: D. Scott, Nothing to disclose; A. Stannard, Nothing to disclose; Z. Arthurs, Nothing to disclose; D. Lynd, Nothing to disclose; H. Monroe, Genesis Concepts and Consultants LLC; A. Ames-Chase, Nothing to disclose; W. Clouse, Nothing to disclose; T. Rasmussen, Nothing to disclose.
Posted April 2012