The Limb Salvage Index (LSI) can be used to evaluate a severely injured lower extremity. It can help decide if the limb can be salvaged or will need to be amputated. The authors are from the University of Tennessee in Chattanooga.
Parameters:
(1) artery
(2) nerve
(3) bone
(4) skin
(5) muscle
(6) deep vein
(7) warm ischemia time
|
Parameter |
Finding |
Points |
|---|---|---|
|
artery |
contusion, intimal tear, partial laceration or avulsion (pseudo-aneurysm) with no distal thrombosis and palpable pedal pulses |
0 |
|
|
complete occlusion of 1 of 3 shank vessels or profunda |
0 |
|
|
occlusion of 2 or more shank vessels |
1 |
|
|
complete laceration, avulsion, or thrombosis of femoral or popliteal vessels without palpable pedal pulses |
1 |
|
|
complete occlusion of femoral or popliteal vessels with no distal runoff available |
2 |
|
|
complete occlusion of 3 shank vessels with no distal runoff available |
2 |
|
nerve |
contusion or stretch injury |
0 |
|
|
minimal clean laceration of femoral, peroneal or tibial nerve |
0 |
|
|
partial transection or avulsion of sciatic nerve |
1 |
|
|
complete or partial transection of femoral, peroneal or tibial nerve |
1 |
|
|
complete transection or avulsion of sciatic nerve |
2 |
|
|
complete transection or avulsion of both peroneal and tibial nerves |
2 |
|
bone |
closed fracture at 1 or 2 sites |
0 |
|
|
open fracture with comminution or with minimal displacement |
0 |
|
|
closed dislocation without fracture |
0 |
|
|
open joint without foreign body |
0 |
|
|
fibula fracture |
0 |
|
|
closed fracture at 3 or more sites on same extremity |
1 |
|
|
open fracture with comminution or moderate to large displacement |
1 |
|
|
segmental fracture |
1 |
|
|
fracture dislocation |
1 |
|
|
open joint with foreign body |
1 |
|
|
bone loss < 3 cm |
1 |
|
|
bone loss >= 3 cm |
2 |
|
|
type III-B or III-C fracture (open fracture with periosteal stripping, gross contamination, extensive soft tissue injury or loss) |
2 |
|
skin |
clean laceration, single or multiple |
0 |
|
|
small avulsion injury with primary closure |
0 |
|
|
first degree burn |
0 |
|
|
delayed closure due to contamination |
1 |
|
|
large avulsion requiring split thickness skin graft or flap closure |
1 |
|
|
second and third degree burn |
1 |
|
muscle |
laceration or avulsion involving a single compartment |
0 |
|
|
laceration or avulsion involving a single tendon |
0 |
|
|
laceration or avulsion involving 2 or more compartments |
1 |
|
|
complete laceration or avulsion of 2 or more tendons |
1 |
|
|
crush injury |
2 |
|
deep vein |
contusion, partial laceration, or partial avulsion |
0 |
|
|
complete laceration or avulsion if alternative route of venous return is intact |
0 |
|
|
superficial vein injury |
0 |
|
|
complete laceration, avulsion or thrombosis with no alternative route of venous return |
1 |
|
warm ischemia time |
< 6 hours |
0 |
|
|
6 – 9 hours |
1 |
|
|
9 – 12 hours |
2 |
|
|
12 – 15 hours |
3 |
|
|
> 15 hours |
4 |
where:
• Shank is the lower leg.
• Bone loss was < 3 cm or > 3 cm in the table. I assigned = 3 cm as 2 points.
points for each category =
= maximum single point assignment
limb salvage index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the more severe the injury.
|
Limb Salvage Index |
Outcome |
|---|---|
|
0 – 5 |
limb salvage successful (51 of 51) |
|
6 – 14 |
amputation (19 of 19) |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
