399 Complex Limb Injuries – Limb Salvage vs Amputation: An Overview of the Factors Influencing Decision-Making and Outcomes

Abstract Aim Complex limb injuries usually comprise of a combination osseous, soft tissue, vascular and neural damage, necessitating prompt accurate initial examination decision-making to maximise optimal patient outcomes. We present the factors affecting as well outcomes following primary amputation or salvage complex extremity injuries, with an emphasis on various scoring systems that endeavour offer prognostic therapeutic guidance orthopaedic surgeons. Method performed literature search PubMed Embase, collated relevant data comprising demographics, injury, system, secondary outcome metrics complications. Results Many systems, each variable factors, have been proposed predict vs in injury (MESS, PSI, LSI, NISSSA, HFS-97), however landmark LEAP trial concluded its final analysis they could not validate them. Whilst scores were useful predicting salvage, inaccurate unreliable low sensitivities Conclusions attempt provide regarding amputation, study has shown poor predictive standards these systems. As such, there is no gold standard algorithmic approach system when making this difficult decision – instead, predictors identified, surgeons need be judicious make joint considering variables other (social, economic, psychological status).