REVIEW Management of the mangled extremity

Abstract The management of a mangled extremity con-tinues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibil-ity, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often pro-longed with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we dis-cuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differ-ences between lower and upper extremity trauma injuries