Freideriki Poutoglidou - Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, Cambridgeshire, UK
Rahul Khan - School of Clinical Medicine, University of Cambridge, Cambridge, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB۲ ۰SP, UK
Matija Krkovic - Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, Cambridgeshire, UK

Objectives: Cases of severe lower limb injuries that previously were amenable only to amputation can now, in certain circumstances, be managed with reconstruction. The present systematic review and meta-analysis was designed to compare the results of amputation and reconstruction in severe lower extremity injuries. Methods: PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were comprehensively searched for studies comparing amputation and reconstruction for severe lower extremity injuries. The search terms used were the following: “amputation”, “reconstruction”, “salvage”, “lower limb”, “lower extremity”, and “mangled limb”, “mangled extremity”, “mangled foot”. Two investigators screened eligible studies, assessed the risk of bias and extracted the data from each study. Meta-analysis was conducted using the Review Manager Software (RevMan, Version ۵.۴). The I۲ index was used to assess heterogeneity. Results: Fifteen studies with ۲,۷۳۲ patients were included. Amputation is associated with lower rehospitalization rates, lower length of stay in the hospital, lower number of operations and additional surgery and fewer cases of infection and osteomyelitis. Limb reconstruction leads to faster return to work and lower rates of depression. The outcomes with respect to function and pain are variable among the studies. Statistically significance was achieved only with regards to rehospitalization and infection rates. Conclusion: This meta-analysis suggests that amputation yields better outcomes in variables during the early postoperative period, while reconstruction is associated with improved outcomes in certain long-term parameters. Severe lower limb injuries should be managed on their individual merit. The results of this study may be a useful tool to aid in the decision-making for the treating surgeon. High-quality Randomized Controlled Studies are still required to further our conclusions. Level of evidence: III

Amputation, lower limb injury, mangled, Meta-analysis, Reconstruction, salvage