Limb Salvage vs. Amputation: The Truth From an Amputee

This is a niche but very important video for people choosing between limb salvation and amputation.

This is something super personal to me that I’ve been wanting to share for a very long time. If you or a loved one are making the very difficult decision, please watch this video before you choose. 

Links mentioned in the video:

📺 Best Foot Forward
📖 Just Don’t Fall for Young Readers 
📂 Amputee Coalition

If you’re watching this video, I’m guessing you’re far into your research. So I will use many technical terms here under the assumption you’re already familiar. Further, since you have the time to be on the internet mulling over this decision, you’re likely facing a tumor situation.

Trauma, by contrast, plays out quickly. So if you're a trauma victim, by the time you watch this, you will have likely already had your first surgery. But hopefully, there are also some insights here for those facing amputation because of trauma or diabetes.

Obviously, I’m not a doctor. This isn’t medical advice. Just anecdotes and personal opinions based on my experience with a tumor.

Here's a bunch of medical studies comparing limb salvage and amputation: https://www.dropbox.com/scl/fo/5esw25...

A DEEP-DIVE INTO AN ANTI-AMPUTATION FLAW IN SOME OF THE MEDICAL RESEARCH:

In the video, I explain the inherent confounding bias against amputation in terms of mortality rates. So I won’t go into that here. But there’s a more subtle (and perhaps more insidious) problem in some of the medical literature.

I don't want to throw shade, so I won't identify which research I find flawed, but several studies I read make this serious mythological error. We know that anywhere from 10 to 30% (depending on the study) of those who have limb salvage will eventually have an amputation due to complications from the limb salvage (e.g., infection, break, failed revision surgeries). This is often called "late amputation." To me, late amputation is clearly an outcome of a failed limb salvage. Yet, several studies include patients with late amputation in the group who had initial amputations.

That means they are removing those with failed limb salvages out of the limb salvage category. So that misrepresents the statistical outcomes for those who have initial limb salvage. This choice further compounds the problem by lumping the failed limb salvage patients in with those who had initial amputations. This negatively skews the amputation data. Late amputations are associated with a litany of negative physical and psychological issues (see Rougraff et al, 1994…all references in Dropbox folder). Melcer et al. (2027) separate late amputation from initial amputation and found along late amputation far worse wound complications, pain, other injury, PTSD, substance use, and more.

The effect is major. In the two studies, I found that disclose their choice to include failed limb salvage with initial amputation, those with late amputation compose a third of the amputee category. One out of three! Thus, these studies cannot be relied upon as an accurate measure of the outcomes for initial surgery.