Limb salvage

The development of microsurgical techniques has increased the chances of salvaging amputated or semiamputated limbs. In the polytraumatized patient, however, salvaging such extremities with severe soft tissue injury increases the systemic inflammatory response, increases the risk of local septic complications, and requires a prolonged operation and recovery in the primary period. Therefore salvage or replantation is not recommended in patients with severe head injury or other injuries requiring intensive treatment. A two-stage replantation procedure with initial osteosynthesis and revascularization, followed 3 days later by final debridement, nerve and tendon suturing, and soft tissue coverage, may help to reduce the length of the primary operation. Amputation in the upper extremity leads to major disability, but the prospects of a successful replantation are much better than for the lower extremity.

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