Use of ring fixator in the management of degloving injuries of lower limb

Rijal, Laxman; Nepal, Pravin; Ansari, Tahir; Joshi, Khima Nanda; Joshi, Anshumala

doi:10.1007/s00590-012-1014-z

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…Complicated limb injury accompanied by massive skin degloving is a very difficult clinical scenario to manage. It is commonly accepted that circumferential degloving cannot be treated simply by suturing the skin in situ, but rather by three steps of therapy: complete debridement, fat resection and thinning of the avulsed skin, and replantation in situ with compression bandaging [15,16]. The patient had circumferential degloving of her left forearm with severe contamination of the muscles and deep soft tissues and was in a state of hemorrhagic shock.…”

Section: Management Of Skin Avulsion Injurymentioning

confidence: 99%

Successful Salvage of the Upper Limb After Crush Injury Requiring Nine Operations: A Case Report

Zeng

Cai

De-chang

et al. 2015

International Surgery

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Emergency treatment of amputation is one of the most frequently used therapeutic methods for patients with severe upper limb crush injury with a mangled extremity severity score (MESS) of more than 7. With the development of advanced surgical repair techniques and reconstructive technology, cases that once required amputation can now be salvaged with appropriate management, and some limb functions may also be reserved. A patient with a severe upper limb crush injury with a MESS score of 10 was treated in our hospital. The limb was salvaged after 9 surgeries over 10 months. The follow-up visits over the next 18 months post-injury showed that the shoulder joint functions were rated as ''excellent'' (90) according to the Neer score, the Harris hip evaluation (HHS) for elbow joint functions was ''good'' (80), and the patient was very satisfied with the overall therapeutic outcome. We conclude from the successful outcome of this extreme injury that salvage attempts should be the first management choice for upper limbs with complex injuries to save as much function as possible. Amputation should only be adopted when the injury is life-threatening or no more function can be saved. The level of evidence was V.Key words: Trauma -Upper limb -Crush injury W ith the rapid development of transportation and modern industries, there is an increasing incidence of limb injuries caused by high energy trauma, such as road traffic and machine injuries. As a consequence of the development of surgical repair and reconstruction technology, limbs damaged by high energy trauma that might have needed to be amputated in the past can now be salvaged by surgical reconstruction.1 The choice between amputation or salvage of lower extremities with mangled injuries was made according to the Gustilo scale, the scale of the Orthopaedic Trauma Association, and Satisfactory outcomes can be achieved with the use of artificial limbs after amputation. However, severe upper limb crush injuries differ as upper limbs have fewer muscles, longer ischemic tolerance times, and complex functions that cannot be substituted by artificial limbs. Togawa et al 4 adopted the MESS system to judge the necessity of amputation in complex upper limb injuries. Two cases with MESS ratings of 11 and 7 were both salvaged by microsurgical repair, while another case with a score of 11 required amputation due to primary shock. 4 Prichayudh et al 5 applied the MESS system in a group of cases with upper limb injuries; all cases with MESS ratings less than 7, and some cases with scores .7, were successfully salvaged. Currently, no appropriate criteria have been developed used to decide whether amputation or salvage is the most appropriate therapy in cases of complex upper limb injury, and this remains a dilemma for both surgeons and patients. 6 This study describes the case of a 49-year-old female patient with left upper limb crush injury after an accident. This was an example of successful limb salvage with functional preservation after 9 surgeries over a 10-month period. Materi...

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Section: Management Of Skin Avulsion Injurymentioning

confidence: 99%