Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XXI: Amputations

Indications

United States Department of Defense
Peer Review Status: Internally Peer Reviewed

The following are clear indications for emergency amputations:

1. Massive injuries in which the components of an extremity are so badly mangled that the extremity is obviously nonviable.
2. Extremities with severe involvement of skin, muscles, and bone with an anesthetic terminus and irreparable nerve damage.
3. Overwhelming local infection, which, despite adequate surgical measures and antibiotic therapy, endangers life.
4. Established death of a limb (vascular gangrene), where vascular repair has failed or has proved to be impractical.
5. Massive septic gangrene (clostridial myositis) is a most compelling indication for amputation. Anaerobic cellulitis or myositis confined to a single muscle group can be managed by resection and is not an indication for amputation.
6. Secondary hemorrhage in the presence of severe infection, even though initial wound surgery apparently may have been adequate. Included in this group are patients in whom the tactical situation precluded adequate early surgical intervention.  

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