Below-knee amputations as a result of land-mine injuries: comparison of primary closure versus delayed primary closure

J Trauma. 1999 Oct;47(4):724-7. doi: 10.1097/00005373-199910000-00018.


Background: Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection than injuries from other weapon systems.

Methods: The results of 474 unilateral traumatic below-knee amputations as a result of land-mine injuries were reviewed. If the delay in evacuation between the injury and arrival to the battle field hospital was less than 6 hours, 392 amputation stumps (group I) were closed primarily after meticulous debridement. Open amputation was performed after debridement in the remaining 82 amputation stumps (group II), because there was a suspicion of ineffective debridement, although they were evacuated in less than 6 hours or delay was more than 6 hours.

Results: Eleven patients in group I (2.8%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in group II. A total of 87.4% of stumps in group I and 81.2% of stumps in group II had healed without a problem. No gas gangrene or tetanus was encountered in any cases.

Conclusion: Our results reveal that primary closure may be done in traumatic below-knee amputations caused by land-mine injuries with an acceptable infection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Amputation, Surgical / adverse effects
  • Amputation, Surgical / methods*
  • Amputation, Surgical / statistics & numerical data
  • Amputation, Surgical / trends
  • Blast Injuries / surgery*
  • Child
  • Child, Preschool
  • Debridement / methods
  • Female
  • Humans
  • Leg Injuries / surgery*
  • Male
  • Middle Aged
  • Reoperation / statistics & numerical data
  • Risk Factors
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control
  • Surgical Wound Infection / surgery
  • Suture Techniques*
  • Time Factors
  • Transportation of Patients / statistics & numerical data
  • Turkey
  • Violence
  • Wound Healing