Severe leg injuries pose a dilemma for surgeons

In recent years, new techniques have enabled surgeons to rebuild the crushed and mangled legs of accident victims that were once considered unsalvageable, leading to fewer amputations.

But some have questioned whether they are doing patients more harm than good by subjecting them to numerous operations -- and often, a longer and more painful recovery.

Now researchers have found that patients with severe leg injuries fare equally well, or poorly, whether they have reconstructive surgery or lose their damaged limbs to amputation.

The sobering truth, doctors said, is that 40% of patients remain severely disabled two years after their injuries, and half do not return to work, no matter which route they take. “If you have reconstruction, you’re going to have more surgery, more hospitalizations and are at risk for complications of those surgeries,” said Dr. Alan L. Jones, chief of orthopedic surgery at the University of Maryland Shock Trauma Center in Baltimore. “But your chance of being able to work and your level of function is going to be about the same.”

The new study, published in the Dec. 12 issue of the New England Journal of Medicine, found that most patients opt for surgery to save their leg.

Researchers said last week that all patients should be given better physical therapy, psychological counseling and vocational training to prepare them for the difficult road ahead.