title: Lower limb salvage: indication and decision making for replantation, revascularisation and amputation.
abstract: Defining reproducible criteria for lower extremity salvage following severe high-energy trauma continues to be one of the most challenging and controversially discussed fields in orthopaedic surgery. At present, however, the difficult performance, limited availability and number of valid reconstructive options for complex injury types, i. e. simultaneous osteoligamentous trauma with neurovascular lesions and severe soft tissue defects ("composite/compound multilayer defects") represent the decisive prognostic injury components triggering and determining the fate of the limb. Consequently, due to the complex injury pattern of the extremity and the overall situation of multiple injured patient the treatment and decision making has to be made in a priority-adapted algorithm. In this treatment algorithm interdisciplinary cooperation with vascular and plastic surgeons is of tremendous importance. Although the number of severely injured patients remains stable in the last decade, changes in the treatment algorithms result from increased survival rates of multiple injured patients and improved modern reconstructive options leading to continuously increasing rates of salvaged limbs. This paper aimed to systematically review the current literature for lower extremity injuries in order to unravel the different surgical treatment options and provide guidelines for decision making with corresponding treatment algorithms for limb salvage. Furthermore, the experiences in the management of mangled extremities in our centre are presented and illustrated/underscored with different cases.
authors.affiliation: Charité - Universitätsmedizin Berlin, CMSC - Center of musculosceletal surgery, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Märdian
authors.forename: K D
authors.initials: KD
authors.lastname: Schaser
authors.forename: F
authors.initials: F
authors.lastname: Wichlas
authors.forename: C
authors.initials: C
authors.lastname: Jakobs
authors.forename: B
authors.initials: B
authors.lastname: Kraphol
authors.forename: P
authors.initials: P
authors.lastname: Schwabe
mesh_terms: D000465:Algorithms; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods; D009104:Multiple Trauma / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D059348:Peripheral Nerve Injuries / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000009:adverse effects / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery; D057772:Vascular System Injuries / Q000601:surgery