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Published in: International Orthopaedics 10/2012

01-10-2012 | Review Article

Amputations in natural disasters and mass casualties: staged approach

Author: Nikolaj Wolfson

Published in: International Orthopaedics | Issue 10/2012

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Abstract

Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.
Literature
1.
go back to reference Lebel E, Blumberg N, Gill A, Merin O, Gelfond R, Bar-On E (2011) External fixator frames as interim damage control for limb injuries: experience in the 2010 Haiti earthquake. J Trauma 71(6):E128–31PubMedCrossRef Lebel E, Blumberg N, Gill A, Merin O, Gelfond R, Bar-On E (2011) External fixator frames as interim damage control for limb injuries: experience in the 2010 Haiti earthquake. J Trauma 71(6):E128–31PubMedCrossRef
2.
go back to reference Borden Institute (2004) Emergency war surgery handbook. 3rd United States Revision 2004. Borden Institute. Walter Reed Army Medical Center, Washington, D.C., chapter 22. Soft Tissue Injuries 22:1–14 Borden Institute (2004) Emergency war surgery handbook. 3rd United States Revision 2004. Borden Institute. Walter Reed Army Medical Center, Washington, D.C., chapter 22. Soft Tissue Injuries 22:1–14
3.
go back to reference Lakstein D, Blumenfeld A, Sokolov T et al (2003) Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma 54(5 suppl):S221–S225PubMed Lakstein D, Blumenfeld A, Sokolov T et al (2003) Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma 54(5 suppl):S221–S225PubMed
4.
go back to reference Scully R, Artz C, Sako Y (1956) An evaluation of the surgeon’s criteria for determining the viability of muscle during debridement. Arch Surg 73:1031–1035CrossRef Scully R, Artz C, Sako Y (1956) An evaluation of the surgeon’s criteria for determining the viability of muscle during debridement. Arch Surg 73:1031–1035CrossRef
5.
6.
go back to reference Better OS, Rubinstein I, Reis ND (2003) Muscle crush compartment syndrome: fulminant local oedema with threatening systemic effects. Kid Int 63:1155–7CrossRef Better OS, Rubinstein I, Reis ND (2003) Muscle crush compartment syndrome: fulminant local oedema with threatening systemic effects. Kid Int 63:1155–7CrossRef
7.
go back to reference Garcia-Covarrubias L, McSwain NE Jr, Van Meter K, Bell RM (2005) Adjuvant HBOT in the management of crush injury and traumatic ischemia: an evidence based approach. Am Surg 71(2):144–51PubMed Garcia-Covarrubias L, McSwain NE Jr, Van Meter K, Bell RM (2005) Adjuvant HBOT in the management of crush injury and traumatic ischemia: an evidence based approach. Am Surg 71(2):144–51PubMed
8.
go back to reference Philips JC (2005) Understanding HBOT and its use in the treatment of compromised skin grafts and flaps. Plast Surg Nurs 25(2):72–80 Philips JC (2005) Understanding HBOT and its use in the treatment of compromised skin grafts and flaps. Plast Surg Nurs 25(2):72–80
9.
go back to reference Reis ND, Better OS (2005) Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties. J Bone Joint Surg Br 87(4):450–3PubMedCrossRef Reis ND, Better OS (2005) Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties. J Bone Joint Surg Br 87(4):450–3PubMedCrossRef
10.
go back to reference Reis ND, Michaelson M (1986) Crush injury to the lower limbs: treatment of the local injury. J Bone Joint Surg Am 68-A:414–18 Reis ND, Michaelson M (1986) Crush injury to the lower limbs: treatment of the local injury. J Bone Joint Surg Am 68-A:414–18
11.
go back to reference Better OS, Rubinstein I, Reis DN (2003) Muscle crush compartment syndrome: fulminant local edema with threatening systemic effects. Kidney Int 63(3):1155–1157PubMedCrossRef Better OS, Rubinstein I, Reis DN (2003) Muscle crush compartment syndrome: fulminant local edema with threatening systemic effects. Kidney Int 63(3):1155–1157PubMedCrossRef
12.
go back to reference Lerner A, Soudry M (2011) Armed conflict injuries to the extremities: A treatment manual. Springer, New YorkCrossRef Lerner A, Soudry M (2011) Armed conflict injuries to the extremities: A treatment manual. Springer, New YorkCrossRef
13.
go back to reference Mubarak SJ, Owen CA (1975) Compartment syndrome and its relation to the crush syndrome: a spectrum of disease. Clin Orthop 113:81–89PubMedCrossRef Mubarak SJ, Owen CA (1975) Compartment syndrome and its relation to the crush syndrome: a spectrum of disease. Clin Orthop 113:81–89PubMedCrossRef
14.
go back to reference Jagodzinski NA (2010) Crush injuries and crush syndrome — a review. Part 1: the systemic injury. Trauma 12:69–88CrossRef Jagodzinski NA (2010) Crush injuries and crush syndrome — a review. Part 1: the systemic injury. Trauma 12:69–88CrossRef
15.
go back to reference Matsen FA III (1980) Compartmental syndromes. Grune & Stratton, Inc., New York Matsen FA III (1980) Compartmental syndromes. Grune & Stratton, Inc., New York
16.
go back to reference Elliott KGB, Johnstone AJ (2003) Diagnosing acute compartment syndrome. J Bone Joint Surg Br 85-B:625–32 Elliott KGB, Johnstone AJ (2003) Diagnosing acute compartment syndrome. J Bone Joint Surg Br 85-B:625–32
17.
go back to reference Bywaters EGL, Beal D (1941) Crush injuries with impairment of renal function. Br Med J I:427–32CrossRef Bywaters EGL, Beal D (1941) Crush injuries with impairment of renal function. Br Med J I:427–32CrossRef
18.
go back to reference Bywaters EGL, Delory GE, Rimington C, Smiles J (1941) Myohaemoglobin in air raid casualties with crushing injury. Biochem J 35:1164–8PubMed Bywaters EGL, Delory GE, Rimington C, Smiles J (1941) Myohaemoglobin in air raid casualties with crushing injury. Biochem J 35:1164–8PubMed
19.
go back to reference Sever SM, Vanholder R, Lameire N (2006) Management of crush-related injuries after disasters. N Engl J Med 354(10):1052–10PubMedCrossRef Sever SM, Vanholder R, Lameire N (2006) Management of crush-related injuries after disasters. N Engl J Med 354(10):1052–10PubMedCrossRef
20.
go back to reference Sever SM, Erek E et al (2002) Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transplant 17:1942–9PubMedCrossRef Sever SM, Erek E et al (2002) Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transplant 17:1942–9PubMedCrossRef
21.
go back to reference Nadjafi I, Atef MR, Broumand B, Rastegar A (1997) Suggested guidelines for treatment of acute renal failure in earthquake victims. Ren Fail 19:655–64PubMedCrossRef Nadjafi I, Atef MR, Broumand B, Rastegar A (1997) Suggested guidelines for treatment of acute renal failure in earthquake victims. Ren Fail 19:655–64PubMedCrossRef
22.
go back to reference Tetsuya M, Toshiharu Y et al (2002) Long term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: prognostic indicators in retrospect. J Trauma 52:33–9CrossRef Tetsuya M, Toshiharu Y et al (2002) Long term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: prognostic indicators in retrospect. J Trauma 52:33–9CrossRef
23.
go back to reference Duman H, Kulahci Y, Sengezer M (2003) Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J 20(3):251–2PubMedCrossRef Duman H, Kulahci Y, Sengezer M (2003) Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J 20(3):251–2PubMedCrossRef
24.
go back to reference Demirkiran O, Dikmen Y, Utku T, Urkmez S (2003) Crush syndrome patients after the Marmara earthquake. Emerg Med J 20(3):247–50PubMedCrossRef Demirkiran O, Dikmen Y, Utku T, Urkmez S (2003) Crush syndrome patients after the Marmara earthquake. Emerg Med J 20(3):247–50PubMedCrossRef
25.
go back to reference Huang KC, Lee TS et al (2002) Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc 101:249–56PubMed Huang KC, Lee TS et al (2002) Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc 101:249–56PubMed
26.
go back to reference Bulut M, Fedkar R, Akkose S, Akgoz S, Ozguc H, Tokyay R (2005) Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emerg Med J 22:494–498PubMedCrossRef Bulut M, Fedkar R, Akkose S, Akgoz S, Ozguc H, Tokyay R (2005) Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emerg Med J 22:494–498PubMedCrossRef
27.
go back to reference Tanaka K (1996) The Kobe earthquake: the system response. A disaster report from Japan. Eur J Emerg Med 3:263–9PubMedCrossRef Tanaka K (1996) The Kobe earthquake: the system response. A disaster report from Japan. Eur J Emerg Med 3:263–9PubMedCrossRef
28.
go back to reference Bar-On E, Lebel E, Kreiss Y, Merin O, Benedict S, Gill A, Lee E, Pirotsy A, Shirov T, Blumberg N (2001) Orthopaedic management in a mega mass casualty situation. The Israel Defense Forces Field Hospital in Haiti following the January 2010 earthquake. Injury 42(10):1053–1059CrossRef Bar-On E, Lebel E, Kreiss Y, Merin O, Benedict S, Gill A, Lee E, Pirotsy A, Shirov T, Blumberg N (2001) Orthopaedic management in a mega mass casualty situation. The Israel Defense Forces Field Hospital in Haiti following the January 2010 earthquake. Injury 42(10):1053–1059CrossRef
29.
go back to reference Bagg MR, Covey DC, Powell ET (2006) Levels of medical care in the global war on terrorism. J Am Acad Orthop Surg 14(10):S7–S9PubMed Bagg MR, Covey DC, Powell ET (2006) Levels of medical care in the global war on terrorism. J Am Acad Orthop Surg 14(10):S7–S9PubMed
30.
go back to reference Depairon M, Krahenbuhl B, Vaucher J (1986) Determination of amputation level by transcutaneous measurement and distal arterial systolic pressure. J Mal Vasc 11(3):229–234PubMed Depairon M, Krahenbuhl B, Vaucher J (1986) Determination of amputation level by transcutaneous measurement and distal arterial systolic pressure. J Mal Vasc 11(3):229–234PubMed
31.
go back to reference Gonzalez EG, Corcoran PJ, Reyes RL (1974) Energy expenditure in bellow-knee amputees: correlation with stump length. Arch Phys Med Rehabil 55:111–119PubMed Gonzalez EG, Corcoran PJ, Reyes RL (1974) Energy expenditure in bellow-knee amputees: correlation with stump length. Arch Phys Med Rehabil 55:111–119PubMed
32.
go back to reference Sarmiento A, Warren WD (1969) A reevaluation of lower extremity amputations. Surg Gynecol Obstet 129:799–802PubMed Sarmiento A, Warren WD (1969) A reevaluation of lower extremity amputations. Surg Gynecol Obstet 129:799–802PubMed
33.
go back to reference Marsden FW (1977) Amputation surgical technique and postoperative management. Aust NZ J Surg 47:384–394CrossRef Marsden FW (1977) Amputation surgical technique and postoperative management. Aust NZ J Surg 47:384–394CrossRef
34.
go back to reference Husum H, Gilbert M, Wisborg T, Pillgram-Larsen J (2004) Prehospital tourniquets: there should be no controversy. J Trauma 56:214–215PubMedCrossRef Husum H, Gilbert M, Wisborg T, Pillgram-Larsen J (2004) Prehospital tourniquets: there should be no controversy. J Trauma 56:214–215PubMedCrossRef
35.
go back to reference Kragh JF, Walters TJ et al (2008) Practical use of emergency tourniquet to stop bleeding in major limb trauma. J Trauma 64:S38–S50PubMedCrossRef Kragh JF, Walters TJ et al (2008) Practical use of emergency tourniquet to stop bleeding in major limb trauma. J Trauma 64:S38–S50PubMedCrossRef
36.
go back to reference Emergency War Surgery (2004) Third United States Revision. United States Government Printing Office, Washington, D.C. Emergency War Surgery (2004) Third United States Revision. United States Government Printing Office, Washington, D.C.
37.
go back to reference Dougherty PJ (2006) War wounds, limb salvage, and traumatic amputations, in Rockwood and Green’s Fractures, 6th edn. Lippincott Wilkins & Williams, Philadelphia, pp 477–496 Dougherty PJ (2006) War wounds, limb salvage, and traumatic amputations, in Rockwood and Green’s Fractures, 6th edn. Lippincott Wilkins & Williams, Philadelphia, pp 477–496
38.
go back to reference Jain AS, Stewart CP, Turner MS (1995) Transtibial amputation using a medially based flap. J R Coll Surg Edinb 40:253–265 Jain AS, Stewart CP, Turner MS (1995) Transtibial amputation using a medially based flap. J R Coll Surg Edinb 40:253–265
39.
go back to reference Bickel WH (1943) Amputation below the knee in occlusive arterial diseases. Surg Clin North Am 23:982–994 Bickel WH (1943) Amputation below the knee in occlusive arterial diseases. Surg Clin North Am 23:982–994
40.
go back to reference Peterson BM (1974) Sagittal incision form bellow-knee amputation in ischemic gangrene. J Bone Joint Surg Br 56:110–114 Peterson BM (1974) Sagittal incision form bellow-knee amputation in ischemic gangrene. J Bone Joint Surg Br 56:110–114
41.
go back to reference Robinson K (1982) Skew flap myoplastic below—knee amputation: a preliminary report. Br J Surg 69:554–557PubMedCrossRef Robinson K (1982) Skew flap myoplastic below—knee amputation: a preliminary report. Br J Surg 69:554–557PubMedCrossRef
42.
go back to reference Burgess EM (1968) The below-knee amputation. Bull Prosthet Res 10:19–25 Burgess EM (1968) The below-knee amputation. Bull Prosthet Res 10:19–25
43.
go back to reference Ruckley CV, Stonebridge PA, Prescott RJ (1991) Skew flap versus long posterior flap in below-knee amputations: multicenter trial. J Vasc Surg 13:423–427PubMedCrossRef Ruckley CV, Stonebridge PA, Prescott RJ (1991) Skew flap versus long posterior flap in below-knee amputations: multicenter trial. J Vasc Surg 13:423–427PubMedCrossRef
44.
go back to reference Chen L, Yang F, Zhang Z-X et al (2008) Free fillet foot flap for salvage of below-knee amputation stump. Chin J Traumatol 11(6):380–384PubMed Chen L, Yang F, Zhang Z-X et al (2008) Free fillet foot flap for salvage of below-knee amputation stump. Chin J Traumatol 11(6):380–384PubMed
45.
go back to reference Sadhotra LP, Singh M, Singh SK (2004) Resurfacing of amputation stumps using free tissue transfer. MJAFI 60(2) Sadhotra LP, Singh M, Singh SK (2004) Resurfacing of amputation stumps using free tissue transfer. MJAFI 60(2)
46.
go back to reference Gallico GG III, Ehrlichman RJ, Jupiter J et al (1987) Free flaps to preserve below-knee amputation stumps: long-term evaluation. Plast Reconstr Surg 79(6):871–878PubMedCrossRef Gallico GG III, Ehrlichman RJ, Jupiter J et al (1987) Free flaps to preserve below-knee amputation stumps: long-term evaluation. Plast Reconstr Surg 79(6):871–878PubMedCrossRef
47.
go back to reference Pinzur M (2004) Knee disarticulation: surgical management. In: Smith DG, Michael JW, Bowker JH (eds) Atlas of amputations and limb deficiencies, 3rd edn. AAOS, Rosemont, pp 517–524 Pinzur M (2004) Knee disarticulation: surgical management. In: Smith DG, Michael JW, Bowker JH (eds) Atlas of amputations and limb deficiencies, 3rd edn. AAOS, Rosemont, pp 517–524
48.
49.
go back to reference Naylor CS, Eaton JT et al (1998) Structure of the key toxin in gas gangrene. Nat Struct Biol 5(8):738–746PubMedCrossRef Naylor CS, Eaton JT et al (1998) Structure of the key toxin in gas gangrene. Nat Struct Biol 5(8):738–746PubMedCrossRef
50.
go back to reference Gonzales D (2005) Crush syndrome. Crit Care Med 33(suppl 1):S 34–41 Gonzales D (2005) Crush syndrome. Crit Care Med 33(suppl 1):S 34–41
51.
go back to reference Malinoski D, Slater M, Mullins R (2004) Crush injury and Rhabdomyolysis. Crit Care Clin 20:171–92PubMedCrossRef Malinoski D, Slater M, Mullins R (2004) Crush injury and Rhabdomyolysis. Crit Care Clin 20:171–92PubMedCrossRef
52.
go back to reference Taisuke S, Takima M (2004) A case of crush syndrome resulting from continues compression of legs by the car. Cent Jpn J Orthop Surg Traumatol 47(6):1251–52 Taisuke S, Takima M (2004) A case of crush syndrome resulting from continues compression of legs by the car. Cent Jpn J Orthop Surg Traumatol 47(6):1251–52
53.
go back to reference Mrsic V, Nasek AV et al (2008) Acute rhabdomyolysis case report and literature review. Acta Med Croatica 62(3):317–22PubMed Mrsic V, Nasek AV et al (2008) Acute rhabdomyolysis case report and literature review. Acta Med Croatica 62(3):317–22PubMed
54.
go back to reference Bosse MJ, MacKenzie E, Kellam JF et al (2001) A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am 83:3–14PubMedCrossRef Bosse MJ, MacKenzie E, Kellam JF et al (2001) A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am 83:3–14PubMedCrossRef
55.
go back to reference McNamara MG, Heckman JD, Corley FG (1994) Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma 8:81–87PubMedCrossRef McNamara MG, Heckman JD, Corley FG (1994) Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma 8:81–87PubMedCrossRef
56.
go back to reference Dougherty PJ (2004) Wartime amputee care. In: Smith DG, Michael JW, Bowker JH (eds) Atlas of amputations and limb deficiencies: surgical, prosthetic and rehabilitation principles, 3rd edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 77–97 Dougherty PJ (2004) Wartime amputee care. In: Smith DG, Michael JW, Bowker JH (eds) Atlas of amputations and limb deficiencies: surgical, prosthetic and rehabilitation principles, 3rd edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 77–97
57.
go back to reference Kalish J, Burke P et al (2008) The return of tourniquets: Original research evaluates the effectiveness of prehospital tourniquets for civilian penetrating extremity injuries. J Emerg Med Serv 33(8):44–54CrossRef Kalish J, Burke P et al (2008) The return of tourniquets: Original research evaluates the effectiveness of prehospital tourniquets for civilian penetrating extremity injuries. J Emerg Med Serv 33(8):44–54CrossRef
58.
go back to reference Simper LB (1993) Below knee amputation in war surgery: a review of 111 amputations with delayed primary closure. J Trauma 34(1):96–98PubMedCrossRef Simper LB (1993) Below knee amputation in war surgery: a review of 111 amputations with delayed primary closure. J Trauma 34(1):96–98PubMedCrossRef
59.
go back to reference Wolfson N, Schecter S (2010) Amputation in combat trauma, Chapter 21. In: Lerner A, Soudry M (eds) Armed conflict injuries to the extremities. Springer, New York, pp 335–354 Wolfson N, Schecter S (2010) Amputation in combat trauma, Chapter 21. In: Lerner A, Soudry M (eds) Armed conflict injuries to the extremities. Springer, New York, pp 335–354
Metadata
Title
Amputations in natural disasters and mass casualties: staged approach
Author
Nikolaj Wolfson
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 10/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-012-1573-y

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