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The Mangled Extremity: An Update

  • Trauma Surgery (J. Diaz, Section Editor)
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Abstract

Purpose of Review

The purpose of this article is to explore the changes over the last 10 years related to limb salvage for even the most complex cases of limb trauma and describe a thoughtful approach to the mangled extremity.

Recent Findings

CT angiography has replaced formal angiography around the country with promising results for evaluating the vascular network of a limb. While concepts in skeletal fixation and vascular reconstruction have remained generally unchanged, advances in nerve grafting and conduit use will guide future directions for limb salvage and improve functional outcomes for patients.

Summary

The surgeon should consider the analogies of home building and limb salvage when planning their reconstructive steps: image review as blueprints, debridement as foundation excavation, skeletal fixation as the foundation and framework, plumbing and electric as vessel and nerve repair, and soft tissue coverage as the roof above the reconstruction.

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Authors and Affiliations

  1. Department of Orthopaedics, R Adams Cowley Shock Trauma Center, 22. S. Greene Street, Baltimore, MD, 20201, USA

    Alexander J. Kish & Raymond A. Pensy

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  1. Alexander J. Kish
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Correspondence to Alexander J. Kish.

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Alexander J. Kish and Raymond A. Pensy declare that they have no conflict of interest.

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Kish, A.J., Pensy, R.A. The Mangled Extremity: An Update. Curr Surg Rep 7, 6 (2019). https://doi.org/10.1007/s40137-019-0226-0

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