Management of Complex Extremity Injuries: Tourniquets, Compartment Syndrome Detection, Fasciotomy, and Amputation Care.

摘要

When it comes to traumatic injuries, the extremities are the most exposed and most frequently affected body part. The arms and legs are exposed to a wide range of wounding mechanisms from falls to high-speed vehicular crashes and industrial accidents. Similarly, combat injures to the extremities result from blasts, multiple fragment munitions, and high-velocity weapons. The heavy toll of these injuries is especially apparent when caring for patients sustaining multiple proximal amputations or mangled limbs from the impact of an improvised explosive device. As the devastation of modern weaponry has increased over the past decade of war, so have the remarkable advances in the management of complex extremity trauma. Complex extremity injuries, or mangled extremities, are those that have sustained a combination of bony, vascular, skin, and soft tissue and/or nerve injury in which amputation may be necessary. Whenembarking on salvaging a severely injured limb, not only does a patient s acute injury and hemodynamic status need to be taken into account but also the ability to provide a functional outcome needs to be considered.