Moderators' Summary: Perceived Performance Differences. Limb Salvage Versus Amputation in the Lower Extremity (Session Ii) (Report‪)‬

Perceived performance differences exist between limb salvage and amputation in the lower extremity. In this session, patient outcomes, injury characteristics, and complications were explored to identify strategies to improve outcomes and define knowledge gaps in the management of severe lower extremity trauma to determine the focus of future research. Severe extremity trauma is a significant cause of morbidity and disability, and these injuries are frequently considered for amputation. The decision to amputate an extremity is usually determined by the patient. The Lower Extremity Assessment Project (LEAP) study showed no difference in outcomes with amputation versus limb salvage at 2- and 7-year follow-up. (1,2) Patient characteristics and the patient's environment are the factors that most affect outcomes, regardless of initial surgical treatment (eg, amputation, limb salvage), medical complications, or the extent of residual physical limitations. The LEAP study indicated that outcomes were influenced more by patient economic, social, and personal resources than by the initial treatment. Mutable factors, such as self-efficacy and catastrophizing, can be improved on, and strategies and interventions that address such factors can lead to better outcomes. The Military Extremity Trauma and Limb Salvage (METALS) study, which is still in the data collection phase, is examining service members who sustained these devastating injuries in combat. Thus far, few differences have been found between amputation and limb salvage. Many of the factors that affected outcomes in the LEAP study likely will affect outcomes in the METALS study.