Limb salvage vs amputation in crush injury due to high energy injury: A case report

Abstract

Limb injury possesses significant problems, both for the treating physician and patient. Numerous problems ranging from disability, limb amputation or even death can occur to the patient. However, the definitive therapy is still debated. A 50 years old man came to the emergency room with a chief complaint of an open wound of his right leg because of a traffic accident. Subsequently, the repair, secondary closure, and skeletal traction were done following the exploration and debridement. During the next follow up, the surrounding tissues seemed to be non-viable. Therefore, the surgeon decided to do an operation with a urologist to perform hip disarticulation and scrotum necrotomy. The patient undergoes repeated debridement in operating theatre and also using negative pressure wound therapy (NPWT). After three months from the first admission, the patient's condition started to deteriorate, and unfortunately, the patient died. There are several scoring systems that can be used to help determine the management of high energy lower extremity injuries. The most used is Mangled Extremity Severity Score (MESS), Limb Salvage Index (LSI) and Predictive Salvage Index (PSI) scores. Hospital type will surely determine the facility and personnel availability. If the facility and personnel are sufficient, limb reconstruction should be attempted first. However, in the end, the family's consent after considering the risk of the surgery will determine the chosen surgery to perform. The surgeon in charge should consider the decision with high vigilance regarding the patient's clinical condition. The decision between limb salvage and amputation should consider the long-term effect which influences the patient's quality of life.