TWO YEARS RETROSPECTIVE REVIEW OF INDICATIONS AND PATTERN OF MAJOR LIMB AMPUTATION AT ADDIS ABABA BURN, EMERGENCY AND TRAUMA HOSPITAL, SAINT PAUL’S MILLENNIUM MEDICAL COLLEGE

Abstract

SUMMARY Background: Limb amputations have been done since time immemorial. The first surgical description of a leg amputation was by Hippocrates (460- 377 BC). Since then, this ancient procedure has been practiced for various punitive, ritual and therapeutic reasons. In modern medicine, limb amputation is considered as a last resort when limb salvation is impossible. Thus limb amputation is considered when the limb is dead, deadly (endangering the patient’s life) or dead loss (functionally useless). Major lower limb amputation results in significant global morbidity and mortality. Apart from physical disability, loss of a limb by an individual causes profound economic, social, and psychological effects on the patients and their families. This effect is more profound in developing countries where prosthetic services are not readily available. Major limb amputations are essentially disfiguring operations that carry a fairly high perioperative mortality and morbidity. Persons who undergone amputation are often viewed as incomplete individuals. However in many cases, amputation of the limb is the only option to save the patient’s life. Objective:-To analyze indications and patterns of major amputations at Addis Ababa Burn, Emergency and Trauma hospital, Saint Paul’s Millennium Medical College, Addis Ababa, Ethiopia from August 2015 up to July 2017 G.C. Methodology:-A retrospective review is conducted among patients who were underwent major limb amputation at AABET hospital, SPHMMC, from August 2015 up to July 2017 G.C. All patients who were underwent major amputation at AABET hospital, SPHMMC, in the given time are studied with no sampling. A structured pretested data collection format is used for data collection. Data is collected by trained orthopedic residents. Data is analyzed with computer programs (SPSS version 22) and the result is presented by numbers, ratios, tables and graphs. Depending on the result appropriate interpretations, discussions, conclusions and recommendations is made. The total cost of the project is 33,286 birr. Results: - Majority (56.7%) patients were below the age of 40 years and 80.6% of patients were male. Trauma is the most common cause of major amputation (47.76%), followed by DM (16.42%) and PAD (16.42%). Most (59.38%) of cases of trauma were due to RTA. Majority (81%) of patients underwent lower limb amputation which makes ratio of Lower limb to upper limb amputation is 4.3:1. Most (76.1%) of patients acquired post-operative complications. SSI is the most common (74.5%) post-operative complication flowed by stump gangrene (21.6%). There was no death during the study period. Wound debridement and closure is the most common (n=29, 56.9%) additional procedure done. There is significant association between indication of amputation and post op complication (P-value=0.008) and also between age of the patient and indication of amputation (P-value=0.000) Conclusion and Recommendation:-Trauma is the most common cause of major amputation followed by DM and PAD. Majority cases (59.38%) of trauma is due to RTA. Systematic disease management and patient education programs should be designed to improve health seeking behavior. Keywords: - major amputation, pattern of amputation, AABET