Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury

WHAT THIS PAPER ADDS This study contributes to a deeper understanding of life with a reconstructed or amputated limb resulting from severe lower extremity trauma with major arterial injury. To the authors' knowledge, this has not previously been investigated. The results may help to improve clinical practice aiming to guide this group of patients and their relatives through a traumatic life changing situation. The study shows that patients are satisfied with the surgical treatment, but they describe the need for continuous interpersonal psychological support. The results could give guidance to healthcare professionals on support for patients in their transition back to normal life. Objective: Severe lower limb trauma with arterial injury is often devastating for the individual. Many studies describe how to manage these injuries when they occur. Short-term functional outcome is quite well described, but the patients are often young, and their suffering is physical, mental, and social from a lifelong perspective. The aim of this study was to report patient experiences of their lives several years after their accidents, and to explore mechanisms of how to improve management. Method: The Swedvasc registry was searched for participants from 1987 to 2011, living in the region of Uppsala, Sweden. Some amputated participants were added from the Walking Rehabilitation Center. There were five reconstructed patients with an intact limb, and three with amputations. In depth interviews were conducted and systematically analyzed, using A Giorgi's descriptive phenomenological method. Results: Eight patients participated, five with reconstructed and three with amputated limbs. Life affecting functional impairments were described by all patients. The patients undergoing amputation had received more structured follow up and support through the Walking Rehabilitation Center. The satisfaction with the cosmetic result was poorer than expected. All patients had developed strategies of how to cope with their impairments and stated they now lived normal lives. Conclusions: Despite substantial physical, psychological, and cosmetic impairments years after severe lower limb trauma, the participants described life as normal and mainly satisfactory. Transition to the new situation could have been facilitated by more frequent and continuous follow up after discharge from hospital, in particular among the non-amputated patients who tend to be lost to follow up. Findings also indicate that family members, have to be acknowledged, strengthened, and supported. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.