Investigation of the effectiveness of prehospital amputation devices on cadavers

Abstract

Amputations take place in the operating rooms. At dangerous sites, circumstances may necessitate on-site amputation to save lives. Currently, there are no evidence-based guidelines for the execution of the amputation or the instruments to be chosen. Furthermore, there are no widely accepted criteria for the standardized characterization of amputation devices. The present study examined the effectiveness of commercially available cutting tools and instruments used by rescue services as possible on-site amputation tools. Five different tools (Holmatro type hydraulic cutter, with two cutting attachments, reciprocating saw, hacksaw, Gigli saw) were used to carry out amputations on designated locations on cadavers (brachial, antebrachial, femoral, and crural regions). During the experiment, the time required for amputation and the number of necessary cutting attempts to detach limbs were recorded. The proximal cut surfaces were analyzed with the help of post-amputation CT scan-based 3D models. An Amputation Index (AI) was determined for each device in each examined region based on the cut surface quality. An Amputation Score (AS) was calculated using the time required for cutting, the number of cutting attempts, and the AI. With the help of AS, the usability of the used devices was determined. According to our scoring system, the reciprocating saw proved the most effective tool. Based on our results, we recommend the consideration and further investigation of the reciprocating saw as a possible on-site amputation device, as well as the introduction of the Amputation Score as an objective and quantitative indicator in the future characterization of on-site amputation devices.

Keywords: Gigli saw amputation score system; Hacksaw; Hydraulic cutter; Prehospital amputation; Reciprocating saw.