Strategies in Trauma and Limb Reconstruction

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VOLUME 7 , ISSUE 2 ( August, 2012 ) > List of Articles


Management of the mangled extremity

Mark L. Prasarn, David L. Helfet, Peter Kloen

Keywords : Mangled extremity, Limb salvage, MESS, Fracture

Citation Information : Prasarn ML, Helfet DL, Kloen P. Management of the mangled extremity. 2012; 7 (2):57-66.

DOI: 10.1007/s11751-012-0137-4

License: CC BY-NC-SA 4.0

Published Online: 31-08-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often prolonged with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.

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