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We present a method of closure of small bowel fistulae associated with open abdomen and hope that this will provide surgeons encountering such complications with a good alternative for surgical management.

A self-constructed shunt is inexpensive, safe, and convenient to insert. Early revascularization of the injured limb with a TIVS can eliminate the adverse effects of prolonged ischemia and enables the surgeons to manage other associated injuries in an unhurried manner. We recommend early insertion of TIVSs in CEVIs.

MESS, an outcome score used to grade the severity of extremity injuries, correlates well with the risk of amputation. Nevertheless, a MESS of >or=7 does not always mandate amputation. On the other hand, the MESS is a better predictor for patients who do not require amputation when the score is <7. The decisions to amputate in patients should be made individually based on clinical signs and an intraoperative finding of irreversible limb ischemia.

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