Mangled extremity--case report, literature review and borderline cases guidelines proposal.

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Abstract

[Indexed for MEDLINE] 13. Indian J Orthop. 2022 Jul 22;56(9):1662-1665. doi: 10.1007/s43465-022-00700-w. eCollection 2022 Sep. Early One Stage Functional Reconstruction of a Mangled Upper Extremity. Chattopadhyay D(1), Kapoor A(1), Jayaprakash PA(1), Goyal T(1)(2). Author information: (1)Department of Burns and Plastic Surgery, All India Institute of Medial Sciences, Veerbhadra Road, Rishikesh, Uttarakhand 249202 India. (2)Department of Orthopaedics, All India Institute of Medical Sciences - Bhatinda, Bhatinda, India. BACKGROUND: A crush injury to the upper extremity with a MESS (Mangled Extremity Severity Score) more than or equal to 10 carries a poor salvage prognosis and functional outcome. Usually performing multiple staged surgeries in these patients make the follow up and rehabilitation regimen long and complicated. This means either the patient doesent return or fails to gain any function. In order to overcome this problem we have done a single stage functional reconstruction in a mangled upper extremity. CASE: A young female presented with a crush injuiry of the upper limb where a functional reconstruction with an LD (Latissimus Dorsi) flap was done 48 hrs after limb salvage surgery. The flap provided cover to the shoulder and elbow joint and also acted as a motor for elbow flexion. RESULT: After 6 months following surgery, the patient had regained active motion in her elbow and shoulder joint, and at 1 year she was able to carry out activities of daily living without any external help. CONCLUSION: Our case demonstrates that the mangled upper extremity can have varied presentations but the surgeon should use every knowledge and technique at their disposal to achieve the maximum chance of autologous functional reconstruction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-022-00700-w. © Indian Orthopaedics Association 2022. DOI: 10.1007/s43465-022-00700-w PMCID: PMC9385893