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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2009

Open Access 01-12-2009 | Research article

The mangled extremity and attempt for limb salvage

Authors: Anastasios V Korompilias, Alexandros E Beris, Marios G Lykissas, Marios D Vekris, Vasileios A Kontogeorgakos, Panayiotis N Soucacos

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2009

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Abstract

Background

The decision, whether to amputate or reconstruct a mangled extremity remains the subject of extensive debate since multiple factors influence the decision.

Methods

Sixty three patients with high energy extremity trauma and attempts at limb salvage were retrospectively reviewed. We analyzed 10 cases of massive extremity trauma where there was made an attempt to salvage limbs, although there was a controversy between salvage and amputation.

Results

All of the patients except one had major vascular injury and ischemia requiring repair. Three patients died. All of the remaining patients were amputated within 15 days after the salvage procedure, mainly because of extremity sepsis. Seven patients required treatment at the intensive care unit. All patients had at least 2 reconstruction procedures and multiple surgical debridements.

Conclusion

The functional outcome should be considered realistically before a salvage decision making for extremities with indeterminate prognosis.
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Literature
1.
Bondurant FJ, Cotler HB, Buckle R, Miller-Crotchett P, Browner BD: The medical and economic impact of severely injured lower extremities. J Trauma. 1988, 28: 1270-1273. 10.1097/00005373-198808000-00023.CrossRefPubMed
2.
Hansen ST: Overview of the severely traumatized lower limb. Reconstruction versus amputation. Clin Orthop Relat Res. 1989, 243: 17-19.PubMed
3.
MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders R, Jones AL, McAndrew MP, Patterson B, McCarthy ML, Rohde CA, LEAP Study Group: LEAP Study Group. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002, 52: 641-649. 10.1097/00005373-200203000-00018.CrossRefPubMed
4.
Xenakis TA, Beris AE, Chrysovitsinos JP, Mavrodontidis AN, Vekris MD, Zacharis K, Soucacos PN: Nonviable injuries of the tibia. Acta Orthop Scand. 1995, 23-26. Suppl 264
5.
Lange RH: Limb reconstruction versus amputation decision making in massive lower extremity trauma. Clin Orthop. 1989, 243: 92-99.PubMed
6.
Soucacos PN, Beris AE, Xenakis TA, Malizos KN, Vekris MD: Open type IIIB and IIIC fractures treated by an orthopaedic microsurgical team. Clin Orthop Relat Res. 1995, 314: 59-66.PubMed
7.
Gregory RT, Gould RJ, Peclet M, Wagner JS, Gilbert DA, Wheeler JR, Snyder SO, Gayle RG, Schwab CW: The mangled extremity syndrome (M.E.S.): A severity grading system for multisystem injury of the extremity. J Trauma. 1985, 25: 1147-1150. 10.1097/00005373-198512000-00005.CrossRefPubMed
8.
Johansen K, Daines M, Howey T, Helfet D, Hansen ST: Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990, 30: 568-572.CrossRefPubMed
9.
Howe HR, Poole GV, Hansen KJ, Clark T, Plonk GW, Koman LA, Pennell TC: Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987, 53: 205-208.PubMed
10.
Heitmann C, Levin LC: The orthoplastic approach for management of the severely traumatized foot and ankle. J Trauma. 2003, 54: 379-390. 10.1097/01.TA.0000028859.26504.7C.CrossRefPubMed
11.
Dirschl DR, Dahners LE: The mangled extremity: when should it be amputated?. J Am Acad Orthop Surg. 1996, 4: 182-190.PubMed
12.
Tomaino MM, Bowen CW: Unsatisfactory outcome after lower limb salvage: decision making pitfalls. Am J Orthop. 1998, 27: 526-529.PubMed
13.
Hansen ST: The type-IIIC tibial fracture: Salvage or amputation. J Bone Joint Surg Am. 1987, 69: 799-800.PubMed
14.
Tornetta P, Olson SA: Amputation versus limb salvage. Instr Course Lect. 1997, 46: 511-518.PubMed
15.
MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, Smith DG, Sanders RW, Jones AL, Starr AJ, McAndrew MP, Patterson BM, Burgess AR, Castillo RC: Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am. 2005, 87: 1801-1809. 10.2106/JBJS.E.00032.CrossRefPubMed
16.
Seiler JG, Richardson JD: Amputation after extremity injury. Am J Surg. 1986, 152: 260-264. 10.1016/0002-9610(86)90253-9.CrossRefPubMed
17.
Fairhurst MJ: The function of below-knee amputee versus the patient with salvaged grade III tibial fracture. Clin Orthop Relat Res. 1994, 301: 227-232.PubMed
18.
Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL: Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am. 1993, 75: 1431-1441.PubMed
19.
Pinzur MS, Pinto MA, Schon LC, Smith DG: Controversies in amputation surgery. Instr Course Lect. 2003, 52: 445-451.PubMed
20.
Karladani AH, Granhed H, Fogdestam I, Styf J: Salvaged limbs after tibial shaft fractures with extensive soft tissue injury: A biopychological function analysis. J Trauma. 2001, 50: 60-64. 10.1097/00005373-200101000-00011.CrossRefPubMed
21.
McNamara MG, Heckman JD, Corley FG: Severe open fractures of the lower extremity: A retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma. 1994, 8: 81-87.CrossRefPubMed
22.
Hiatt MD, Farmer JM, Teasdall RD: The decision to salvage or amputate a severely injured limb. J South Orthop Assoc. 2000, 9: 72-78.PubMed
23.
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Cyril JK: A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001, 83: 3-14. 10.1302/0301-620X.83B1.11952.CrossRefPubMed
24.
Durham RM, Mistry BM, Mazuski JE, Shapiro M, Jacobs D: Outcome and utility of scoring systems in the management of the mangled extremity. Am J Surg. 1996, 172: 569-574. 10.1016/S0002-9610(96)00245-0.CrossRefPubMed
Metadata
Title
The mangled extremity and attempt for limb salvage
Authors
Anastasios V Korompilias
Alexandros E Beris
Marios G Lykissas
Marios D Vekris
Vasileios A Kontogeorgakos
Panayiotis N Soucacos
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2009
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-4-4

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