LEAP Study

Lower Extremity Assessment Project


Set up


Multicentre Prospective Outcome Study

- 601 patients

- severe, limb threatening lower extremity injuries

- 8 level 1 trauma centres




IIIC / IIIB / selected IIIA

- knee dislocations or closed tibial fractures associated with vascular injuries

- major ST injuries

- severe foot / ankle injuries (open pilon, type IIIB ankle)




GCS < 15 day 21

Third degree burns

Spinal cord deficit


Sensate sole


Bosse et al JBJS Am Dec 2005


3 groups of patients

1.  26 patients with insensate sole at time of admission who underwent amputation

2.  29 patients with insensate sole at time of admission who underwent limb salvage

3.  Case matched group with sensate sole who underwent limb salvage


Assessed at 12 and 24 months

- orthopaedic surgeon

- occupational therapist


- sensation assessed


Sensate v insensate salvage groups

- no difference late amputation

- no functional difference

- similar sensory examinations at 24 months


Insensate salvage v insensate amputation

- amputation more likely to use walking aid

- amputation more likely to have difficulty with stairs



- insensate sole is a poor predictor of eventual function and poor guide to amputation

- a large number have reversible ischaemia or neuropraxia


Outcomes of Reconstruction or Amputation


Bosse et al N Eng J Medicine Dec 2002


Case matched

- functional outcome for amputation or reconstruction the same