• Kewen van Rensburg, Wilme Steyn, Ismail Cassimjee, and Maeyane Stephens Moeng.
• Department of Surgery, Division of Vascular Surgery, Charlotte-Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa. kewen191@gmail.com.
• Eur J Trauma Emerg Surg. 2025 Jan 24; 51 (1): 6363.

PurposeTo determine modifiable and non-modifiable factors contributing to limb loss in PAI the relevance and accuracy of published scoring systems for PAI within a South African State hospital.MethodologyRetrospective review of patients (> 18 years) with PAI, presenting to CMJAH trauma unit from 1 January 2017 to 31 December 2022.ResultsSixty-four patient records were analysed. Thirty (46.9%) had blunt trauma and thirty-four (53.1%) had penetrating trauma. Gunshot wounds (GSW) were the most common mechanism of injury (MOI). Blunt PAI had a 40% amputation rate and penetrating trauma, 33.3%. Forty-seven (73.4%) had a delay to surgery of > 6 h. The mean time to arrival at our emergency department was 478 min, and the mean time from arrival to surgery was 368 min (total delay of 838 min). The primary amputation rate was 28.6%, and 63.5% had successful limb salvage surgeries. The secondary amputation rate was 7.8%.ConclusionCompared to international literature, our rate of primary amputation is high (10% vs. 28.8%) and prolonged ischaemia is the likely cause. Only 17 (26.6%) patients presented before 6 h. Of the 45 patients that had an attempt at revascularisation, 7.8% had a secondary amputation. Thus, despite prolonged ischaemia, revascularisation should be attempted in patients with at least two viable compartments on fasciotomy. The MESS and POPSAVEIT scoring systems should not be relied on in patients with delayed presentations. Strengthening referral triage for suspected PAI to Level 1 Trauma centres directly will decrease the delays and likely improve the outcomes.© 2025. The Author(s).

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