Management of extremity injuries with external fixator or Ilizarov devices. Cooperative effort between orthopedic and plastic surgeons.

Major advances in the last decade have improved the treatment and outcome of patients with moderate to severe lower extremity injuries. Better transport and emergency room facilities, which allow more prompt repair of injuries, advances in bone stabilization, and better methods of soft-tissue reconstruction have led to a significant decrease in amputation and infection rates. This article presents the Mangled Extremity Severity Score (MESS) index and Gustilo's classification to evaluate injuries. Orthopedic, plastic, and vascular surgeons collaborate to manage these injuries in five categories: limb viability, timing, debridement, fixation, and secondary reconstruction. Finally, two cases are presented to demonstrate practical application of these steps, and guiding principles are outlined.