Academic Journal
Decision-making in patients facing limb salvage versus amputation after lower extremity trauma: A scoping review.
| Τίτλος: | Decision-making in patients facing limb salvage versus amputation after lower extremity trauma: A scoping review. |
|---|---|
| Συγγραφείς: | Engel R; University of Chicago Medical Center, Division of Plastic Surgery, Chicago, IL, United States. Electronic address: ricardo.engel@uchicagomedicine.org., Landon E; University of Chicago Medical Center, Department of Medicine, Section of Infectious Diseases & Global Health, Chicago, IL, United States., Bell E; University of Chicago Medical Center, Department of Medicine, Section of Infectious Diseases & Global Health, Chicago, IL, United States., Erdman MK; University of Chicago Medical Center, Department of Orthopedic Surgery, Chicago, IL, United States., Beederman M; University of Chicago Medical Center, Division of Plastic Surgery, Chicago, IL, United States. |
| Πηγή: | Injury [Injury] 2026 Oct; Vol. 57 (10), pp. 113680. Date of Electronic Publication: 2026 Sep 05. |
| Τύπος έκδοσης: | Journal Article; Scoping Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0226040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0267 (Electronic) Linking ISSN: 00201383 NLM ISO Abbreviation: Injury Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2002->: Amsterdam : Elsevier Original Publication: Bristol, Wright. |
| Ιατρικοί όροι (MeSH): | Amputation, Surgical*/psychology , Leg Injuries*/surgery , Leg Injuries*/psychology , Limb Salvage*/psychology , Decision Making*, Patient Participation/psychology ; Humans ; Decision Making, Shared ; Quality of Life |
| Περίληψη: | Objective: To review the psychosocial and clinical factors influencing patient decision-making between limb salvage and amputation after major lower extremity trauma (MLET), and to identify strategies to support shared, informed decision-making. Summary Background Data: Patients with MLET must often rapidly decide between limb salvage and amputation, a decision with major functional and psychosocial consequences. Existing clinical tools emphasize anatomic and physiologic criteria but overlook patient values and quality-of-life considerations. Prior work suggests outcomes are often similar between salvage and amputation, and that psychosocial adaptation drives satisfaction more than surgical choice. Methods: Narrative literature review synthesizing evidence from trauma surgery, orthopedic surgery, plastic surgery, psychology, and economics sources to characterize psychosocial and clinical barriers to informed decision-making in MLET. Results: Grief responses, cognitive biases (loss aversion, bounded rationality, sunk-cost fallacy), and decision fatigue were identified as key psychosocial barriers. Traumatic brain injury, opioid analgesia, and substance use were identified as clinical factors impairing cognition and capacity. These factors can impair communication and the pursuit of informed, shared decision-making. Conclusions: Decision-making in MLET is shaped by overlapping psychosocial and clinical barriers to informed choice. Addressing these through trauma-informed communication, multidisciplinary consistency, and structured decision aids may improve shared decision-making. Prospective, MLET-specific research is needed. (Copyright © 2026 Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Amputation; Decision-making; Free Flap; Informed consent; Limb, salvage; Lower extremity; Microsurgery; Microvascular; Reconstruction; Trauma |
| Entry Date(s): | Date Created: 20260909 Date Completed: 20261007 Latest Revision: 20261009 |
| Update Code: | 20261009 |
| DOI: | 10.1016/j.injury.2026.113680 |
| PMID: | 42715917 |
| Βάση Δεδομένων: | MEDLINE |
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