Painful Sequelae Following Limb Salvage: Etiology and Management (Report‪)‬

Approximately one half of combat injuries are associated with severe trauma to the lower extremity. (1) Improved wound therapy, aggressive surgical approaches, early wound closure, and antibiotic therapy have resulted in limb salvage rates 90%. (2) Chronic pain and impaired function are common sequelae of limb salvage and are major reasons why these patients request conversion to amputation. The accumulating evidence from the current wars substantiates clinical observations that injured soldiers with poorly controlled pain go on to experience chronic pain and posttraumatic stress disorder. (3,4) Results from the Lower Extremity Assessment Project study have shown that poorly controlled postoperative pain is linked to increased disability (eg, decreased participation in therapy, increased delay in return to work), psychological distress (eg, anxiety, depression, posttraumatic stress disorder), social dysfunction, and chronic pain. (5-8) Chronic pain produces unnecessary suffering and has a negative effect on long-term function. Pain following limb salvage must be managed early, aggressively, and comprehensively.