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Review
. 2012 Nov;36(11):2189-95.
doi: 10.1007/s00264-012-1638-y. Epub 2012 Aug 25.

Current management of the mangled upper extremity

Marko Bumbasirevic  1 , Milan Stevanovic, Aleksandar Lesic, Henry D E Atkinson
Affiliations
Review

Current management of the mangled upper extremity

Marko Bumbasirevic et al. Int Orthop. 2012 Nov.

Abstract

Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for mangled upper extremities, amputation and salvage reconstruction. With advances in our understanding of human physiology and basic science, and with the development of new fixation devices, modern microsurgical techniques and the possibility of different types of bony and soft tissue reconstruction, the clinical and functional outcomes are often good, and certainly preferable to those of contemporary prosthetics. Early or even immediate (emergency) complete upper extremity reconstruction appears to give better results than delayed or late reconstruction and should be the treatment of choice where possible. Before any reconstruction is attempted, injuries to other organs must be excluded. Each step in the assessment and treatment of a mangled extremity is of utmost importance. These include radical tissue debridement, prophylactic antibiotics, copious irrigation with a lavage system, stable bone fixation, revascularization, nerve repair, and soft tissue coverage. Well-planned and early rehabilitation leads to a better functional outcome. Despite the use of scoring systems to help guide decisions and predict outcomes, the decision to reconstruct or to amputate still ultimately lies with the surgical judgment and experience of the treating surgeon.

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Figures

Fig. 1
Fig. 1
A case of complete upper extremity amputation. After the replantation transpositional latissimus pedicle functional flap was done in order to obtain elbow flexion. Even after the proximal level replantation a good nerve recovery with reasonable function is possible
Fig. 2
Fig. 2
A case of the severe distal forearm injury. After the revascularization, tendon reconstruction a free omental flap was done. A very good functional result was obtained
See this image and copyright information in PMC

References

    1. 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(12):1147–1150. doi: 10.1097/00005373-198512000-00005. - DOI - PubMed
    1. Covey DC. Blast and fragment injuries of the musculoskeletal system. J Bone Joint Surg Am. 2002;84A(7):1221–34. - PubMed
    1. Okike K, Bhattacharyya T. Trends in the management of the open fractures, a critical anlysis. J Bone Joint Surg Am. 2006;88(12):2739–48. doi: 10.2106/JBJS.F.00146. - DOI - PubMed
    1. Tintle SM, Baechler MF, Nanos GP, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: part II:upper extremity and future directions. J Bone Joint Surg Am. 2010;92(18):2934–45. doi: 10.2106/JBJS.J.00258. - DOI - PubMed
    1. Heller L, Levin S. In: Bone and soft tissue reconstruction in “Rockwood and Green’s fractures in adults”. 6. Bucholz RW, Heckman JD, Court-Brown C, editors. Philadelphia: Lippincott Co; 2006. pp. 497–547.

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