The Insensate Foot Following Severe Lower Extremity Trauma

Bosse, Michael J.; McCarthy, Melissa L.; Jones, Alan L.; Webb, Lawrence X.; Sims, Stephen H.; Sanders, Roy; MacKenzie, Ellen

doi:10.2106/00004623-200512000-00001

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…Another historical indication for limb amputation was the nonfunctional posterior tibial nerve [7]. But, as the LEAP study group has demonstrated, the loss of plantar sensation is no more an indication for amputation [15]. Advanced age may also be included among the indications for primary amputation [16].…”

Section: Discussionmentioning

confidence: 99%

Scoring Systems in Major Extremity Traumas

Demir¹,

Karşıdağ²

2020

Limb Amputation

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In the emergency room, every mangled extremity presents with its unique features. Each case requires a different approach and special care, while a surgeon has almost always the same facilities and armamentarium in her/his own setting. Thanks to the advancements in the bone fixation technologies and microsurgical field, the attempts to salvage mangled or even amputated limbs have increased. However, it is still controversial how the decision should be made for salvage or amputation. That is why several scoring systems have been proposed based on retrospective analysis of this group of patients in order to generate a systematic approach and to optimize the outcome. Although they help the surgeon to decide salvation over amputation, or vice versa, the same scores in different patient populations should be interpreted meticulously, and the treatment plan should be established accordingly. The ultimate success is being able to make the most accurate decision possible, and this can be only achieved with experience and extensive knowledge along with sufficient surgical skills.

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Section: Discussionmentioning

confidence: 99%

Scoring Systems in Major Extremity Traumas

Demir¹,

Karşıdağ²

2020

Limb Amputation

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Management of the mangled extremity

Prasarn¹,

Helfet²,

Kloen³

2012

Strategies in Trauma and Limb Reconstruction

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The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often prolonged with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.

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Amputation

2020

Standards for the Management of Open Fractures

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The decision to amputate rather than reconstruct a severely injured limb (‘mangled extremity’) has historically been one of the most difficult choices faced by a trauma surgeon. The surgeon’s responsibility is heightened by the knowledge that delayed or incorrect decision-making may lead to worse outcomes. Unfortunately, hard data upon which to base reliable decisions remain elusive. A prospective analysis of the use of scoring systems including the Limb Salvage Index, the Predictive Salvage Index, the Hanover Fracture Scale, and the NISSSA (Nerve injury, Ischaemia, Soft-tissue contamination, Skeletal damage, Shock, Age) and MESS (Mangled Extremity Severity Score) scores did not validate the clinical utility of any of the scoring algorithms.

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The Insensate Foot Following Severe Lower Extremity Trauma

Cited by 4 publications

References 22 publications

Scoring Systems in Major Extremity Traumas

Scoring Systems in Major Extremity Traumas

Management of the mangled extremity

Amputation

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