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Found., LA2016-0457"],"award-info":[{"award-number":["LIO-799621","Sigurd and Elsa Goljes Mem. Found., LA2016-0457"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the past decades, surgical management of limb injuries in high\u2010resource settings has improved. The possibility of limb salvage has increased. It is not known whether similar changes have transpired in resource\u2010scarce conflict settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study using routinely collected patient data from the International Committee of the Red Cross hospitals in Pakistan was conducted. Consecutive data from 2009 to 2012 (535 patients) and randomly selected data from 1992 to 1995 (463 patients) were used. Only patients with weapon\u2010related limb injuries were included. Differences in surgical procedures were assessed with logistic regression to adjust for confounding factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Less injuries were related to mines in 2009\u20132012 than in 1992\u20131995 (3.7% vs. 20.3%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), but injuries from bombs, shells and fragments were more frequent (38.5% vs. 19.4%, <jats:italic>p<\/jats:italic> \u2009&lt;\u20090.0001) as were injuries with only a small degree of tissue damage (42.0% vs. 31.1%, <jats:italic>p<\/jats:italic> \u2009=\u20090.0004). In the logistic regression, the time period did not affect the risk of amputation, debridement, length of hospital stay or in\u2010hospital mortality. The use of external fixation (OR 0.56, 95% CI 0.33\u20130.96, <jats:italic>p<\/jats:italic> \u2009=\u20090.04), split skin grafts (OR 0.31, 95% CI 0.21\u20130.45, <jats:italic>p<\/jats:italic> \u2009&lt;\u20090.0001) and blood transfusion (OR 0.43, 95% CI 0.28\u20130.66, <jats:italic>p<\/jats:italic> \u2009=\u20090.0001) was less frequent in 2009\u20132012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this resource\u2010scarce conflict setting, the risk of amputation appears unchanged over time, while the use of external fixation and split skin grafts was less common in 2009\u20132012 than in 1992\u20131995. These results contrast with the improved limb salvage results seen in high\u2010resource settings. It likely reflects the challenges of providing advanced limb\u2010preserving techniques in a resource\u2010scarce setting.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05110-y","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T19:02:22Z","timestamp":1565636542000},"page":"2681-2688","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Trends in Demographics and Surgical Treatment of Weapon\u2010Related Limb Injuries Over Two Decades in a Resource\u2010Scarce Setting"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7002-7768","authenticated-orcid":false,"given":"M\u00e5ns","family":"Muhrbeck","sequence":"first","affiliation":[{"name":"Department of Surgery, and Department of Clinical and Experimental Medicine Link\u00f6ping University 603 79 Norrk\u00f6ping Sweden"},{"name":"Center for Teaching and Research in Disaster Medicine and Traumatology University Hospital Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaspar","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Southern Denmark Odense Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaher","family":"Osman","sequence":"additional","affiliation":[{"name":"International Committee of the Red Cross Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"von Schreeb","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Wladis","sequence":"additional","affiliation":[{"name":"Center for Teaching and Research in Disaster Medicine and Traumatology University Hospital Link\u00f6ping Sweden"},{"name":"Department of Clinical and Experimental Medicine Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Surgery, and Department of Clinical and Experimental Medicine Link\u00f6ping University 603 79 Norrk\u00f6ping Sweden"},{"name":"International Medical Programme, Center for Teaching and Research in Disaster Medicine and Traumatology University Hospital Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010199907000\u201000021"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4911"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010199710000\u201000031"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020\u20101383(87)90181\u20101"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010018\u20104817\u20101"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/165.6.463"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31815b35aa"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010017\u20104160\u2010y"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(16)31678\u20106"},{"volume-title":"Global incidence of major, non\u2010fatal amputation due to traumatic causes","year":"2017","author":"McDonald C","key":"e_1_2_12_11_1"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.17269\/CJPH.108.6093"},{"key":"e_1_2_12_13_1","first-page":"92","article-title":"Limb reconstruction versus amputation decision making in massive lower extremity trauma","volume":"10243","author":"Lange RH","year":"1989","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31818d69c3"},{"key":"e_1_2_12_15_1","first-page":"875","article-title":"Limb amputation and limb deficiency: epidemiology and recent trends in the United States","volume":"95","author":"Dillingham TR","year":"2002","journal-title":"South Med J"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1007"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.039354"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1816383113000039"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1162\/016228801753212868"},{"key":"e_1_2_12_20_1","unstructured":"CuttatP News bulletin ICRC Hospital Peshawar(2009)International Committee of the Red Cross Geneva.https:\/\/www.icrc.org\/en\/doc\/assets\/files\/otherbulletin\u2010icrc\u2010march\u201009.pdf. 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