LEAP

An analysis of outcomes of reconstruction or amputation after leg-threatening injuries.

Bosse MJ, MacKenzie EJ, Kellam JF, et al. The New England journal of medicine 2002 · PMID 12477942 · doi:10.1056/nejmoa012604

Question

Do patients with limb-threatening lower limb injuries do better functionally with limb salvage or with amputation?

Design

Prospective multicentre observational cohort (Lower Extremity Assessment Project) in US level I trauma centres.

Patients

Patients with severe high-energy lower limb injuries below the distal femur treated with reconstruction or amputation.

Intervention

Limb reconstruction (salvage)

Comparison

Amputation

Primary outcome

Sickness Impact Profile at 2 years

Key result

Functional outcomes at 2 years were similar after salvage and amputation, with substantial disability in both groups. Poor outcome was linked to complications needing readmission and to social and economic factors rather than treatment choice, and reconstruction carried a higher rehospitalisation rate.

Limitations

Treatment was not randomised, and the cohort was a US civilian population with a high proportion of adverse social factors.

Impact on practice

Informs shared decision-making in mangled limbs: salvage and amputation give comparable medium-term function, so patient factors, complications and rehabilitation needs should guide the choice.