School of Medicine, University of Belgrade; Clinic for orthopedic surgery and traumatology, Clinical Centre of Serbia; Serbian Academy of Sciences and Arts, Belgrade.
School of Medicine, University of Belgrade; Clinic for orthopedic surgery and traumatology, Clinical Centre of Serbia.
Injury. 2021 Dec;52(12):3555-3560. doi: 10.1016/j.injury.2021.03.028. Epub 2021 Mar 12.
A mangled extremity is the most devastating limb injury and presents a challenge for the orthopedic surgeon. There are two main treatment options, reconstruction or amputation, but sometimes indications for either are not clear. There are many pro and contra arguments for both options. To make the decision easier numerous score systems have been introduced, but the final decision is based on the judgment and experience of the treating surgeon. Early extremity reconstruction appears to give better results than delayed or late reconstruction and should be the treatment of choice where possible. The goal in reconstruction of a lower extremity is to restore and maintain balance and ambulation, while restoration of an upper extremity's numerous functions is more demanding. In this paper the authors describe and suggest treatment approaches in patients with a severely mangled extremity, including assessment and treatment of all injured tissues, using defined protocols, with special attention to bone stabilization, revascularization, soft-tissue coverage and nerve reconstruction. These have a great impact on the outcome and function of the injured extremity. Rehabilitation and return to the preinjury level is slow and sometimes uncertain.
严重毁损的肢体是最具破坏性的肢体损伤，给矫形外科医生带来了挑战。有两种主要的治疗选择，重建或截肢，但有时这两种选择的适应证并不明确。这两种选择都有很多赞成和反对的理由。为了做出更简单的决策，已经引入了许多评分系统，但最终的决策还是基于治疗外科医生的判断和经验。早期的肢体重建似乎比延迟或晚期重建效果更好，只要有可能，应该是治疗的首选。下肢重建的目标是恢复和维持平衡和步行能力，而恢复上肢的许多功能则更具挑战性。本文作者描述并提出了严重毁损肢体患者的治疗方法，包括使用既定方案评估和治疗所有受伤组织，特别注意骨稳定性、血运重建、软组织覆盖和神经重建。这些对受伤肢体的预后和功能有重大影响。康复和恢复到受伤前的水平是缓慢的，有时是不确定的。
