Evidence brief
An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries
No significant difference in functional outcomes between amputation and reconstruction at 2 years
Both groups had significant disability
Existing limb salvage scores (MESS, LSI) did not reliably predict salvage success
569 patients with severe lower extremity trauma
Reconstruction had higher complication rates but similar final function
LEAP study demonstrated that neither amputation nor reconstruction is inherently superior for functional outcomes in mangled extremities. The decision should involve patient preferences, and existing scoring systems should not be used to mandate amputation.
Key exam point: LEAP showed limb salvage scores (MESS, LSI, PSI, NISSSA) are NOT reliable predictors of outcome. Don't use scores to 'rule in' amputation. Decision should be individualized. Know the 2-year functional equivalence finding.
Level II
Lesser quality RCT or prospective comparative study