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Risk Factors for Amputations after Extremity Burns
Paul Adenuga BS, Michelle Lee MD, Andrea Monson BS, Charles Yowler MD
Burn Care Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland OH
2013-02-27
Presenter: Paul Adenuga BS
Affidavit:
This work was originally conceived by Charles Yowler, MD and Michelle Lee, MD and the execution was a collaborative effort between them, Andrea Monson, BS and Paul Adenuga, BS.
Director Name: Bahman Guyuron, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: This study sought to identify risk factors for limb amputation following extremity burns or frostbite.
Methods: A retrospective chart review of all admitted burns and frostbite patients with extremity amputations at MetroHealth Medical Center from 1996-2012. The study population included those with amputations after flame, scald, chemical or electrical burns and frostbite. Preoperative variables included demographics, medical history and burn characteristics, and operative variables included number of salvage attempts and level of amputation. Infections and non-elective admissions were also documented. Descriptive statistical analysis was utilized.
Results: Of 1755 total burn or frostbite admissions, 31 patients met the inclusion criteria of extremity injuries requiring amputation. The majority were male (71%), 55% Caucasians and 42% African Americans. Average age was 53 years (19-92 years).
Common medical co-morbidities included hypertension (32%) and diabetes (26%), while psychiatric disorders (32%), alcoholism (26%) and tobacco use (35.5%) were prevalent as well.
68% of burns were >10% TBSA and all burns resulting in amputations were full thickness upon admission. The most common burn etiology was flame (58%), followed by frostbite (23%), electric (9.6%), scald (6%) and chemical (3%).
45% of amputations involved the fingers and hand, 6% were above wrist or elbow, 26% were BKA and16% were AKA.
Flame and electric burns had the highest attempted salvage rate (both 100%), and flame burns had the highest associated mortality (22%).
Conclusion: Male gender, flame burn, full thickness burns, tobacco and alcohol use, and psychiatric disorders are prevalent characteristics in patients with extremity burns and frostbite requiring amputations.
