Mangled Extremity: Amputation Versus Salvage

Abstract

The mangled extremity is defined as massive anatomic disruption of the bone, muscle, tendon, nerve, vasculature, and/or soft tissue that threatens limb viability and functionality. The clinical team is left with the decision whether to amputate or salvage and reconstruct. The decision should integrate baseline factors (e.g., pre-injury comorbidities, functional status), injury factors (e.g., location and severity of mangled extremity, wound contamination, total burden of traumatic injuries, physiologic severity of illness), patient preference, and available personnel and resources. From the primary survey through the recovery phases, the management is best summarized as “life before limb”. Extremity tourniquets are key adjuncts in managing uncontrolled hemorrhage. Amputation or limb salvage, both are associated with risks of long-term disability and unemployment. Management decisions should be patient-centered and multidisciplinary with extensive communication among providers, patients, and families, and should be appropriately documented.