Limb reconstruction versus amputation decision making in massive lower extremity trauma.

Massive lower extremity trauma, in particular open tibial fractures with associated vascular injuries, presents an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Unfortunately, the literature to date is deficient in providing sound and defensible guidelines for primary amputation. Individual patient variables, specific extremity injury characteristics, and associated injuries must all be weighed before a decision can be reached. Further prospective studies are necessary before a well-defined protocol for primary amputation can be properly developed.

[1]  J. Mcnamara,et al.  Management of fractures with associated arterial injury in combat casualties. , 1973, The Journal of trauma.

[2]  A. Diethelm,et al.  The Surgical Treatment of Arterial Injuries in the Civilian Population , 1979, Annals of surgery.

[3]  C. Ottolenghi.  Vascular complications in injuries about the knee joint. , 1982, Clinical orthopaedics and related research.

[4]  W. McQuillan,et al.  Ischaemia complicating injury. A report of thirty-seven cases. , 1968, The Journal of bone and joint surgery. British volume.

[5]  D. N. Williams,et al.  Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. , 1984, The Journal of trauma.

[6]  R. Hobson,et al.  Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates. , 1984, The American surgeon.

[7]  R. Goodman.  The type-IIIC tibial fracture. Salvage or amputation. , 1988, The Journal of bone and joint surgery. American volume.

[8]  M. Sher.  Principles in the Management of Arterial Injuries Associated with Fracture/Dislocations , 1975, Annals of surgery.

[9]  L. A. Koman,et al.  Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. , 1987, The American surgeon.

[10]  P. M. Hutchins.  The outcome of severe tibial injury. , 1981, Injury.

[11]  M. Debakey,et al.  Battle injuries of the arteries in World War II; an analysis of 2,471 cases. , 1946, Transactions of the Southern Surgical Association. Southern Surgical Association.

[12]  G. W. Fisher.  Acute arterial injuries treated by the United States Army Medical Service in Vietnam, 1965-1966. , 1967, The Journal of trauma.

[13]  Robert W. Anderson,et al.  Vascular Trauma in Vietnam Battle Casualties: An Analysis of 55 Consecutive Cases , 1968, Annals of surgery.

[14]  K. Johansen,et al.  Open tibial fractures with associated vascular injuries: prognosis for limb salvage. , 1985, The Journal of trauma.

[15]  N. Hoover.  Injuries of the popliteal artery associated with fractures and dislocations. , 1961, The Surgical clinics of North America.

[16]  T. O'donnell,et al.  Arterial injuries associated with fractures and/or dislocations of the knee. , 1977, The Journal of trauma.

[17]  J. Weigelt,et al.  Arterial injuries below the knee: fifty-one patients with 82 injuries. , 1983, The Journal of trauma.

[18]  J. B. Peacock,et al.  Factors limiting extremity function following vascular injury. , 1977, The Journal of trauma.

[19]  J R Wheeler,et al.  The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. , 1985, The Journal of trauma.

[20]  W. Snyder.  Vascular injuries near the knee: an updated series and overview of the problem. , 1982, Surgery.

[21]  N. Rich,et al.  Popliteal artery injuries in Vietnam. , 1969, American journal of surgery.

[22]  B. Browner,et al.  The medical and economic impact of severely injured lower extremities. , 1988, The Journal of trauma.

[23]  E. Chao,et al.  A quantitative analysis of donor site morbidity after vascularized fibula transfer , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  J. Richardson,et al.  Arterial injuries with lower extremity fracture. , 1983, Surgery.