Limb Salvage or Amputation in Gustilo Type 3B and 3C Injuries, Report of 2 Cases and Review of Literature

Decision making between primary amputation and limb salvation in Gustilo Type 3B and 3C injuries can test the competence of any experienced orthopedic surgeon. Immediately following extremity injury, assesment may be imperfect due to tissue edema, difficulty in deciding in assessing viability of freshly injured tissues (what looks viable may turn out to be non viable later), clinically one may not be able to palpate distal pulsations and doppler studies may not be available at all centres. Large number of factors have to be considered objectively as defined by various predictive scores for evaluation. There can be inter-observer variation in scoring systems, thus leaving much on surgeons experience for making decisions. Involvement of vascular surgeons and plastic surgeons may be of great value. Waiting for 24-48 hours may be of definitive value in deciding amputation versus limb salvage especially in centres where modern technological facilities in terms of investigation and management are not available. Experience of a surgeon rather than scoring systems may be the deciding factor.