Management of the Mangled Upper Extremity

Abstract

* Management of the mangled upper extremity prioritizes life before limb, with control of bleeding most often achieved with direct pressure.* Infection is reduced by immediate antibiotic administration, excisional debridement within 24 hours, skeletal stabilization, and wound management that promotes healing.* High-pressure irrigation, soaps, and prolonged antibiotics have unclear benefit, and possible harm, with respect to the ultimate outcome of the mangled upper extremity.* Complex bone, nervous, vascular, and soft-tissue injuries require individually tailored reconstruction, frequently performed at a specialized center.* Occupational therapy, physical therapy, prosthetics, and psychological support are essential parts of the management and should be considered at each stage throughout recovery.

Complex Reconstruction of a Mangled Forearm Following Washing Machine Trauma

“…When treating an injured limb, it is vital to treat life-threatening injuries first before addressing the limb, unless the limb is the source of catastrophic bleeding [ 4 , 5 ]. Bleeding is frequently controlled with pressure; but there are situations, such as this case, in which a tourniquet is appropriate [ 4 ].…”

“…When treating an injured limb, it is vital to treat life-threatening injuries first before addressing the limb, unless the limb is the source of catastrophic bleeding [ 4 , 5 ]. Bleeding is frequently controlled with pressure; but there are situations, such as this case, in which a tourniquet is appropriate [ 4 ]. Although tourniquets can cause nerve injury as well as limb ischemia, they have been shown to have a very low rate of complications when applied in the field prior to hospital admission [ 6 , 7 ].…”

“…Initially, the status of limb perfusion must be determined, and vascular injuries should either be repaired or temporized using a shunt if the vascular repair would hinder further reconstruction [ 4 ]. After the administration of antibiotics, devitalized tissue should be debrided in the operating room.…”

“…After the administration of antibiotics, devitalized tissue should be debrided in the operating room. Timing for debridement has been controversial, but multiple studies have shown that there is no difference in outcomes if done within 24 hours [ 4 , 7 ]. In this case, the decision was made to debride immediately due to mottled digits and bony instability.…”

Artroplastia total na lesão complexa do cotovelo

“…These fractures have a great impact in the quality of life, and limb functionality must be prioritized. 1 Elbow arthroplasty is a valid therapeutic option in these highly complex cases despite the known need for further revision surgeries. It represents a possibility of limb salvage instead of amputation, which was a frequent option in the past.…”