Soft Tissue Lower Limb Trauma

摘要

Soft tissue lower limb trauma ranges from pretibial lacerations in the elderly to limb threatening open fractures with vascular injuries. Patients with these wounds initially present to Emergency Medicine specialists and General Practitioners (GP) and so a broad knowledge of the concepts involved will aid these doctors in correctly assessing injuries and deciding which patients need specialist referral. The factors that influence management of a leg injury are wound site and its relation to the relevant anatomy, the nature of the wound (e.g. crush, laceration, degloving), the energy involved, contamination and tissues involved, the presence of coexisting injuries and patient co morbidities. Advances in the surgical management of high-energy lower limb injuries mean that there are many more patients in the community with salvaged limbs who in the past would have had amputations and prostheses. This means that today’s GP is much more likely to encounter patients who have had complex lower limb reconstructive surgery. This review explains the nature and reasons for these procedures and their possible complications. Introduction Soft tissue lower limb trauma ranges from pretibial lacerations in the elderly to limb threatening open fractures with vascular injuries. Patients with these wounds initially present to Emergency Medicine specialists and General Practitioners (GP) and so a broad knowledge of the concepts involved will aid these doctors in correctly assessing injuries and deciding which patients need specialist referral. The factors that influence management of a leg injury are wound site and its relation to the relevant anatomy, the nature of the wound (e.g. crush, laceration, degloving), the energy involved, contamination and tissues involved, the presence of coexisting injuries and patient co morbidities. Advances in the surgical management of high-energy lower limb injuries mean that there are many more patients in the community with salvaged limbs who in the past would have had amputations and prostheses. This means that today’s GP is much more likely to encounter patients who have had complex lower limb reconstructive surgery. This review explains the nature and reasons for these procedures and their possible complications. Methods Pubmed and Medline were searched using the terms ‘leg’, ‘lower limb’, ‘trauma’ and ‘reconstruction’ from 1998 onwards. The highest quality articles were selected comprising original papers, reviews, recommendations, and consensus reports. The studies are all population-based, prospective or retrospective observational reports. The field of reconstructive surgery does not lend itself to randomized controlled trials and much of the evidence inevitably comes from case series and observational reports. In addition, those seminal papers that have substantially influenced practice are referenced. Assessment of Lower Limb Injuries What is the crucial anatomy to know?