- mangled extremity severity score:
- main controversy is whether tibial defect reconstruction and soft tissue reconstruction are indicated;
- high velocity open tibia frx, w/ concomitant nerve, artery, &/or massive soft tissue disruption;
- types IIIB and IIIC tibial frx w/ assoc w/ insensate foot or major bony injuries;
- open tibia fractures w/ severe comorbidity (elderly pt, renal failure ect);
- infected non unions, skin necrosis, skin loss in elderly pt w/ comorbidity;
- technique of below knee amputation
- prevent infection:
- irrigation (w/ > 9 lit) and repeated debridment;
- debridement of open tibia fractures
- consider leaving the wound open, wound vac, w/ delayed closure at 3-5 days post-injury;
- type II and III open frx repeat debridment is required to evaluate amount of devitalized & potentially necrotic soft tissue;
- soft tissue coverage as soon as the wound is clean;
- skin grafting & free flaps are often required;
- STSG over bone is rarely successful;
- BKA Prosthesis:
- Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation: Preliminary Results of the Mangled Extremity Severity Score.
- The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.
Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.
The severely traumatized lower limb: reconstruction versus amputation.
Limb reconstruction versus amputation decision making in massive lower extremity trauma.
The function of below-knee amputee versus the patient with salvaged grade III tibial fracture.
Open Tibial Fractures with Severe Soft-Tissue Loss. Limb Salvage Compared with Below-the-Knee Amputation.
Lower limb replantation. A report of nine cases.
The Insensate Foot Following Severe Lower Extremity Trauma: An Indication for Amputation?
To Reconstruct or Not to Reconstruct?
An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.
Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.
Open tibia fracture: amputation versus limb salvage. Opinion: below-the-knee amputation.