FIELD AMPUTATIONS

article-2071691-0f1a491f00000578-478_634x399A paper in EMJ compares various methods for performing field amputations. I can’t say I ever had to do one myself. However, some of the people I work with have performed amputations on rapidly deteriorating entrapped trauma victims.

Most them have relied on the standard Gigli technique where they scalpel the soft tissues and cut the bone with the Gigli saw. Apparently it is painfully slow, especially as it is performed on a trauma patient that is super sick. One colleague recommends using the firemens’ pneumatic cutters.

The study

Reciprocating saw

Reciprocating saw

Cadaver study comparing four amputation methods. All techniques relied on equipment that is readily available in the prehospital environment.

Time to full amputation of the femoral bone being the primary outcome. Secondary outcomes was the quality of the cut as graded by a home-made scaling system (1= Very poor cut to 5=excellent quality smooth cut with minimal tissue injury).

Hacksaw

Hacksaw

The methods compared were

  • The classic Gigli technique where soft tissues are cut with a scalpel followed by Gigli-ing the bone.
  • Fire service hacksaw.
  • Holmatro ‘Jaws of Life’ pneumatic cutters.
  • Battery driven reciprocating saw cutting through soft tissue and bone.

Results

The Jaws of Life baby!

The Jaws of Life

The Reciprocating saw was the fastest, achieving amputation at 22 seconds with high quality cuts. Unfortunately it resulted in significant spraying and aerosolisation of blood and tissue that would require a visor and a FFP3-grade breathing protection.

The Holmatro achieved amputation at 53 seconds. Some remaining soft tissue was cut with trauma shears. This technique resulted in the worst quality cuts as it resulted in significant bone splintering and soft tissue injury.

Gigli

Gigli

The Hacksaw required 88 seconds and resulted in excellent quality cuts. Authors noted that this technique required someone stabilising the leg.

The Gigli saw technique required 91 seconds.

Take-home message
The Jaws of Life cutters is a reasonable alternative to the Gigli as it is much faster. The reciprocating saw less so given the aerosolisation and risk of contamination.

I recommend downloading and reading the paper. It is open access and lives here:

Man or machine? An experimental study of prehospital emergency amputation. Leech C, Porter K. Emerg Med J. 2016 Sep;33(9):641-4.

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4 Responses to FIELD AMPUTATIONS

  1. Kalle says:

    In the article it says scalpel and hacksaw took 88 seconds, but gave the best bone cut. The conclusion felt a bit odd with the 22 seconds cited in this post.

  2. K says:

    Kalle,
    Thanks. Fixed that.

  3. Caroline says:

    Thanks for flagging up the paper! Just to say that whilst the Holmatro cut looked the worse visually, the CT scans showed that there was actually minimal bone splintering of the proximal stump – there was just a horrible splintering noise when it was being performed.
    I wouldn’t recommend using fire service cutting equipment for the standard pre-hospital amputation – only if the car is on fire or the patient is drowning underwater etc.
    And top tip….. if your Gigli saw does snap, the fire service hacksaw is an easy-to-use effective alternative for cutting bone.

  4. Pingback: Distance CME – FIELD AMPUTATIONS How Quick is quick, you’d be surprised

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