OUTCOMES FOLLOWING LIMB RECONSTRUCTION VS AMPUTATION

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This is a proposal to continue and extend an ongoing prospective study of outcomes following high energy lower extremity trauma. The principal objectives of the Lower Extremity Assessment Project or 'LEAP' study were to (1) compare clinical and functional outcomes for those undergoing amputation versus successful reconstruction, (2) identify early clinical predictors of successful limb salvage and good functional outcomes, and (3) identify characteristics of the patient and his environment that mediate the quality of functional outcomes and quality of well being. The investigators propose to extend the followup to 5 years post-injury. Preliminary results of the 2 year follow-up indicate substantial improvement in physical function over time. However, 2 year outcomes are far from optimal. Only 50 percent of all patients are back to their major role activity; SIP scores are indicative of significant disability. Furthermore, little difference in outcomes was observed among those undergoing amputation versus reconstruction. Without longer term follow-up of these individuals, the investigators state they have an incomplete picture of recovery and expected levels of permanent impairment and disability over all patients, and by treatment. Although patients appear to have achieved a plateau in terms of clinical recovery, there is reason to believe that functional recovery may continue to improve for some patients; for others, function may deteriorate. The 5-year followup will address the following specific aims: (1) to determine the long term (5 year) outcomes and quality of life following high energy lower extremity trauma and to compare outcomes of those undergoing amputation during the initial hospitalization, amputation following discharge from the hospital, and successful reconstruction; (2) to estimate 5 year and lifetime costs associated with amputation versus reconstruction following high energy lower extremity trauma; and (3) to determine the correlates of good outcome at 5 years post injury for both amputation and reconstruction patients. In addition, they propose to extend analysis of the 2-year data to address several important clinical and methodological issues.