Abstract Introduction Complex foot trauma poses a significant management challenge, including the decision of whether to amputate or reconstruct. Evidence on outcomes is limited and inconsistent, especially within reconstruction subtypes and psychiatric burden. This study aims to compare outcomes between primary reconstruction (PR), primary amputation (PA) and secondary amputation (SA). Methods A single-centre, retrospective, observational cohort study of patients managed for complex open foot fractures was conducted between January 2019 and December 2023 at Leeds Teaching Hospitals NHS Trust, UK. Variables included patient demographics, injury characteristics, operative details, time to full weight-bearing, psychiatric morbidity and healthcare utilisation. Statistical analysis was used to compare variables and outcomes, summarised as medians and interquartile ranges where appropriate. Results Fifty-eight patients were included (PR = 49, PA = 5, SA = 4). The secondary amputation cohort had a significantly greater healthcare burden than the primary amputation and primary reconstruction. Those who had free flap closure had longer hospital stay than direct closure, greater duration of operations than direct closure and SSG and greater cost of care. A quarter of patients (15/58) acquired psychiatric morbidity and were disproportionately younger than those who did not acquire psychiatric morbidity. A relationship was found between ISS and the number of new psychiatric diagnoses. Conclusions SA was associated with the greatest clinical and economic burden, reflecting the compounded costs and morbidity of failed salvage. Younger patients were disproportionately affected by psychiatric morbidity, highlighting the need for integrated, early psychological support alongside multidisciplinary surgical care.
Poon et al. (Sun,) studied this question.
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