outcome of multidisciplinary approach to mangled extremity

ABSTRACT

Mangled extremities are associated with high rate of amputations and non-functional limbs. Factors responsible for such poor outcome were studied. Thirty patients with mangled extremities underwent vascular reconstruction, orthopedic fixation and soft tissue coverage sequentially, as required. Vascular injuries were treated using autogenous vein, primary repair, ligation and observation. Fracture fixation of 26 extremities included closed management [17 fractures and 2 dislocations], external or internal fixation. Twenty-eight patients had soft tissue injuries that required primary closure. Split-thickness skin grafts, fasciocutaneous flaps, muscle flaps and a fasciocutaneous and a muscle flap. Two out of 14 nerve injuries were successfully repaired early. Functional limb salvage was achieved in 23 patients. Two non-functional upper extremities resulted from non-repairable nerve injuries. Two amputations resulted from none or failure of revascularization. Three patients died from associated severe head injuries. Successful salvage of mangled extremity can be achieved by implementing a multidisciplinary team approach: