Elective proximal lower limb amputation in spinal cord injury patients with chronic pressure ulcers: improve quality of life, function, and shorten hospital stay. Case report.

BACKGROUND Pressure ulcers are common among patients with spinal cord injury and can be very challenging to treat. The treatment involves multidisciplinary approach and ranges from simple pressure relieve and wound dressings to a more radical treatment like proximal lower limb amputations, especially in chronic cases with potential detrimental effects to physical and mental health. AIM To report the outcome of three spinal cord injury patients with a history of chronic pressure ulcers who underwent elective proximal lower limb amputations. METHODS We reviewed three patients; patient 1 with bilateral hip disarticulation, patient 2 with left hip disarticulation and right transfemoral amputation and patient 3 with bilateral transfemoral amputation. The clinical impact and functional outcome of the patients were reviewed by comparing the length of hospital stay, the short version of the World Health Organization Quality of Life (WHOQOL- BREF) score and the Spinal Cord Independence Measures (SCIM) score before and after amputation. RESULTS After amputation, all patients have marked reduction in hospital stay (mean reduction of 208 days), improvement in WHOQOL-BREF scores(mean increment of 14.68 scores) and minimal improvement in SCIM scores (mean increment of 3 scores) compared to before amputation. CONCLUSIONS Proximal amputations of the lower limbs are procedures that can be considered as part of the treatment for complicated pressure ulcers. In properly selected patients, it can reduce the number of hospital stay, improve the quality of life and functional outcome.