Secondary amputation: a qualitative study of quality of life in patients after primary limb salvage surgery and after later ablative sarcoma treatment

Abstract

Objective: This study focuses on how patients experience the time following amputation after primary limb salvage surgery due to musculoskeletal malignancies. Limb salvage is state of the art in the treatment of musculoskeletal tumours. Nonetheless, in some cases, limb salvage can become problematic over time, resulting in poorer limb function and septic outcomes. This raises the question of whether amputation is indicated sooner rather than later. Patients who have undergone secondary amputation might retrospectively prefer a different approach.

Design: Interview study.

Subjects/patients: Patients who underwent primary limb salvage surgery followed by later ablative sarcoma treatment.

Methods: Semi-structured interviews and the standardized "Prosthetic Limb Users Survey of Mobility" questionnaire were conducted. Interviews were analysed according to Mayring content analysis method.

Results: Amputation is perceived as an improvement after a long course of illness with little quality of life. By enhancing the amputation environment and providing detailed information regarding quality of life afterwards, emotional pressure could be reduced and patient satisfaction improved.

Conclusion: Surgical options for ablation should be openly communicated earlier when consulting patients experiencing recurrent complications that might eventually lead to amputation. Supporting factors that subsequently may help to improve quality of life after amputation were further identified.

Fig. 1

Qualitative measurement: how Mayring content analysis is conducted using first the transcribed interviews to create categories and later sorting them by categories and subcategories using Marginnote 3. Copyright © 2020 Beijing YunSi Software. This example shows how the category “pain” and subcategories like “phantom pain” are found, how transcripts are assessed using those categories, and how found data are combined and evaluated.

Fig. 2

Main categories and side categories developed referring to Mayring.

Fig. 3

Overlapping influences on QoL.

Fig. 4

Comparison of patients’ amputation height, PLUS Mobility Score and VAS.