Application of damage control in severe traumatic limb salvage / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the importance of damage control in limb salvage in severe trauma.</p><p><b>METHODS</b>A retrospective analysis of 14 patients with severe limb trauma was performed from June 2007 to December 2009. There are 13 males and 1 female,ranging in age from 6 to 62 years with an average of 38.4 years. According to the Tscherne's classification about soft tissue injury, 10 cases were type Fr.O III, 2 cases were type Fr.O IV, and 2 cases were type Fr.C II. All the patients received the first operation in our hospital. In the first stage, all the patients received debridemen directed by damage control after the situation was evaluated. The broken arteries were anastomosed, bone fractures were fixed with external fixation, wound were covered with the application of VSD. In the second stage, the soft tissue defect was reconstructed, and the plate fixation of unstable fracture was performed.</p><p><b>RESULTS</b>The patients were followed up, and the duration ranged from 6 to 19 months. All limbs were salvaged successfully with two-stage operations,except one Fr.O IV fracture reveived the third operation. No osteomyelitis occurred, and the functions of the salvaged limbs were satisfied. Two patients had non-union at 9 month later, and were cured after re-debridement and bone replantation. The time of fracture union ranged from 5 to 15 months.</p><p><b>CONCLUSION</b>Severe traumatic limbs always have high rate of infection and extremity disability because the severe injury of soft tissue. The application of damage control can reduce the further injury of soft tissue, which is better for the success of limb salvage.</p>