Current Problems in Surgery
Volume 46, Issue 11 , Pages 851-926 , November 2009

The Mangled Extremity

    COL
  • Robert M. Rush Jr, MD

      Affiliations

    • Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Clinical Instructor in Surgery, University of Washington, Chief of Surgery, Madigan Army Medical Center, Tacoma, Washington
    • , LTC
  • Alec C. Beekley, MD

      Affiliations

    • Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Clinical Instructor in Surgery, University of Washington, Madigan Army Medical Center, Tacoma, Washington
    • , LTC
  • Eric G. Puttler, MD

      Affiliations

    • Attending Surgeon, Madigan Army Medical Center, Tacoma, Washington
    • , CPT
  • Randy J. Kjorstad, MD

      Affiliations

    • Chief of Orthopedic Trauma, Madigan Army Medical Center, Tacoma, Washington

References 

  1. ACS Committee on Trauma. Advanced Trauma Life Support for Doctors, Student Course Manual. In: 7th ed.. Chicago, IL: American College of Surgeons; 2004;
  2. Feliciano DV. Management of the Mangeld Extremity (pamphlet). Chicago: American College of Surgeons Committee on Trauma; 2002;
  3. Ramalingam T, Pathak G, Barker P. A method for determining the rate of major limb amputations in battle casualties: experiences of a British Field Hospital in Iraq, 2003. Ann R Coll Surg Engl. 2005;87:113–116
  4. Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Holcomb JB. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008;22:43–46
  5. Noe A. Extremity injury in war: a brief history. J Am Acad Orthop Surg. 2006;14:S1–S6
  6. Joy RJT. Military medicine. In:  Crowley R,  Parker G editor. The Reader's Companion to Military History. New York: Houghton Mifflin; 1996;
  7. Llewellyn CH. Education and training for war surgery. Mil Med. 1990;155:192–193
  8. Rich NM, Rhee P. An historical tour of vascular injury management: from its inception to the new millennium. Surg Clin North Am. 2001;81:1199–1215
  9. Price BA. The influence of military surgeons in the development of vascular surgery. J R Army Med Corps. 1999;145:148–152
  10. Barros D'Sa AAB, Hood JM, Blair PHB. Vascular injuries of the limbs. In:  Barros D'Sa AAB,  Chant ADB editor. Emergency Vascular and Endovascular Surgical Practice. London: Hodder Arnold; 2005;p. 375–400
  11. Dougherty PJ. Wartime amputations. Mil Med. 1993;158:755–763
  12. Helling TS, McNabney WK. The role of amputation in the management of battlefield casualties: a history of two millennia. J Trauma. 2000;49:930–939
  13. DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II: an analysis of 2,471 cases. Ann Surg. 1946;123:534–579
  14. Nelson DL. External fixation for distal radias fractures. eradius.com11-3-2001;Accessed Dec 5, 2008
  15. Feliciano D. Orthopaedic management decisions. In:  Browner BD editors. Skeletal Trauma: Basic Science, Management and Reconstruction. Philadelphia, PA: W. B. Saunders Company; 2003;
  16. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10:359–369
  17. Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system development in a theater of war: experiences from Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2006;61:1366–1372
  18. Gawande A. Casualties of war—military care for the wounded from Iraq and Afghanistan. N Engl J Med. 2004;351:2471–2475
  19. Barros D'Sa AAB. The value of shunting in complex vascular trauma of the lower limb. In:  Earnshaw JJ,  Murray CK editor. Evidence for Vascular Surgery. Shropshire, England: TFM Publications; 1999;p. 189–196
  20. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–1931
  21. MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002;52:641–649
  22. MacKenzie EJ, Bosse MJ, Castillo RC, Smith DG, Webb LX, Kellam JF, et al. Functional outcomes following trauma-related lower-extremity amputation. J Bone Joint Surg Am. 2004;86-A:1636–1645
  23. Owens BD, Kragh JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2008;64:295–299
  24. Pollak AN. The need for peer reviewed extremity trauma research by the Department of Defense fiscal year 2009 Department of Defense Appropriations. Washington, DC: Senate Appropriations Committee, Subcommittee on Defense (hearing); June 4, 2008;
  25. Rich NM, Jarstfer BS, Geer TM. Popliteal artery repair failure: causes and possible prevention. J Cardiovasc Surg (Torino). 1974;15:340–351
  26. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55–62
  27. Dorlac WC, DeBakey ME, Holcomb JB, Fagan SP, Kwong KL, Dorlac GR, et al. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005;59:217–222
  28. PHTLS—Prehospital Trauma Life Support. St Louis: Mosby; 2003;
  29. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458
  30. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742–746
  31. Caudle RJ, Stern PJ. Severe open fractures of the tibia. J Bone Joint Surg Am. 1987;69:801–807
  32. Byrd HS, Spicer TE, Cierney G. Management of open tibial fractures. Plast Reconstr Surg. 1985;76:719–730
  33. Brumback RJ, Jones AL. Interobserver agreement in the classification of open fractures of the tibia (The results of a survey of two hundred and forty-five orthopaedic surgeons). J Bone Joint Surg Am. 1994;76:1162–1166
  34. Horn BD, Rettig ME. Interobserver reliability in the Gustilo and Anderson classification of open fractures. J Orthop Trauma. 1993;7:357–360
  35. Hiatt MD, Farmer JM, Teasdall RD. The decision to salvage or amputate a severely injured limb. J South Orthop Assoc. 2000;9:72–78
  36. Bondurant FJ, Cotler HB, Buckle R, Miller-Crotchett P, Browner BD. The medical and economic impact of severely injured lower extremities. J Trauma. 1988;28:1270–1273
  37. Pasquale MD, Frykberg ER, Tinkoff GH. Management of complex extremity trauma. Bull Am Coll Surg. 2006;91:36–38
  38. Katzman SS, Dickson K. Determining the prognosis for limb salvage in major vascular injuries with associated open tibial fractures. Orthop Rev. 1992;21:195–199
  39. McAndrew MP, Lantz BA. Initial care of massively traumatized lower extremities. Clin Orthop Relat Res. 1989;20–29
  40. Gregory RT, Gould RJ, Peclet M, Wagner JS, Gilbert DA, Wheeler JR, et al. The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. J Trauma. 1985;25:1147–1150
  41. Howe HR, Poole GV, Hansen KJ, Clark T, Plonk GW, Koman LA, et al. Salvage of lower extremities following combined orthopedic and vascular trauma (A predictive salvage index). Am Surg. 1987;53:205–208
  42. Sudkamp N, Haas N, Flory PJ, Tscherne H, Berger A. [Criteria for amputation, reconstruction and replantation of extremities in multiple trauma patients]. Chirurg. 1989;60:774–781
  43. Seekamp A, Kontopp H, Tscherne H. [Hannover Fracture Scale '98—reevaluation and new prospects for an established score system]. Unfallchirurg. 2001;104:601–610
  44. Bonanni F, Rhodes M, Lucke JF. The futility of predictive scoring of mangled lower extremities. J Trauma. 1993;34:99–104
  45. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83A:3–14
  46. Hoogendoorn JM, van der Werken CC. The Mangled Leg. Eur J Trauma. 2002;28:1–10
  47. Johansen K, Daines M, Howey T, Helfet D, Hansen ST. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30:568–572
  48. Slauterbeck JR, Britton C, Moneim MS, Clevenger FW. Mangled extremity severity score: an accurate guide to treatment of the severely injured upper extremity. J Orthop Trauma. 1994;8:282–285
  49. Fagelman MF, Epps HR, Rang M. Mangled extremity severity score in children. J Pediatr Orthop. 2002;22:182–184
  50. Russell WL, Sailors DM, Whittle TB, Fisher DF, Burns RP. Limb salvage versus traumatic amputation (A decision based on a seven-part predictive index). Ann Surg. 1991;213:473–480
  51. McNamara MG, Heckman JD, Corley FG. Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma. 1994;8:81–87
  52. Durham RM, Mistry BM, Mazuski JE, Shapiro M, Jacobs D. Outcome and utility of scoring systems in the management of the mangled extremity. Am J Surg. 1996;172:569–573
  53. Schreiber MA, Tieu B. Hemostasis in Operation Iraqi Freedom III. Surgery. 2007;142:S61–S66
  54. Roberts K, Revell M, Youssef H, Bradbury AW, Adam DJ. Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2006;31:339–344
  55. Soreide E, Deakin CD. Pre-hospital fluid therapy in the critically injured patient—a clinical update. Injury. 2005;36:1001–1010
  56. Hai SA. Permissive hypotensive resuscitation—an evolving concept in trauma. J Pak Med Assoc. 2004;54:434–436
  57. Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54:S221–S225
  58. Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64:S28–S37
  59. Kragh JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64:S38–S49
  60. Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, et al. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. J Trauma. 2008;64:1093–1099
  61. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma. 2006;60:655–658
  62. Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–1109
  63. Bickell WH, Stern S. Fluid replacement for hypotensive injury victims: how, when and what risks?. Curr Opin Anaesthesiol. 1998;11:177–180
  64. Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307–310
  65. Borgman M, Spinella PC, Perkins J, Repine T, Grathwohl K, Holcomb JB. Blood Product Replacement Affects Survival in Patients Receiving Massive Transfusions at a Combat Support Hospital. Poster presentation at the 1st International Miltranet Symposium, Koblenz, Germany, May 2006.
  66. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–1130
  67. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44
  68. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, et al. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury. 2007;38:298–304
  69. Fox CJ, Gillespie DL, Cox ED, Kragh JF, Mehta SG, Salinas J, et al. Damage control resuscitation for vascular surgery in a combat support hospital. J Trauma. 2008;65:1–9
  70. Fox CJ, Gillespie DL, Cox ED, Mehta SG, Kragh JF, Salinas J, et al. The effectiveness of a damage control resuscitation strategy for vascular injury in a combat support hospital: results of a case control study. J Trauma. 2008;64:S99–S106
  71. Johansen K, Lynch K, Paun M, Copass M. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991;31:515–519
  72. Kendall RW, Taylor DC, Salvian AJ, O'Brien PJ. The role of arteriography in assessing vascular injuries associated with dislocations of the knee. J Trauma. 1993;35:875–878
  73. Starnes BW, Beekley AC, Sebesta JA, Andersen CA, Rush RM. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2006;60:432–442
  74. Chitwood WR, Rankin JS, Bollinger RR, Moylan JA. Brachial artery reconstruction using the heparin-bonded Sundt shunt. Surgery. 1981;89:355–358
  75. Dawson DL, Putnam AT, Light JT, Ihnat DM, Kissinger DP, Rasmussen TE, et al. Temporary arterial shunts to maintain limb perfusion after arterial injury: an animal study. J Trauma. 1999;47:64–71
  76. Eger M, Golcman L, Goldstein A, Hirsch M. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet. 1971;132:67–70
  77. Johansen K, Bandyk D, Thiele B, Hansen ST. Temporary intraluminal shunts: resolution of a management dilemma in complex vascular injuries. J Trauma. 1982;22:395–402
  78. Nunley JA, Koman LA, Urbaniak JR. Arterial shunting as an adjunct to major limb revascularization. Ann Surg. 1981;193:271–273
  79. Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18:91–99
  80. Clouse WD, Rasmussen TE, Perlstein J, Sutherland MJ, Peck MA, Eliason JL, et al. Upper extremity vascular injury: a current in-theater wartime report from Operation Iraqi Freedom. Ann Vasc Surg. 2006;20:429–434
  81. Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61:8–12
  82. Chambers LW, Green DJ, Gillingham BL, Sample K, Rhee P, Brown C, et al. The experience of the US Marine Corps' Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom. J Trauma. 2006;60:1155–1161
  83. Clouse WD, Rasmussen TE, Peck MA, Eliason JL, Cox MW, Bowser AN, et al. In-theater management of vascular injury: 2 years of the Balad Vascular Registry. J Am Coll Surg. 2007;204:625–632
  84. Chambers LW, Green DJ, Sample K, Gillingham BL, Rhee P, Brown C, et al. Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during Operation Iraqi Freedom: one unit's experience. J Trauma. 2006;61:824–830
  85. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10:359–369
  86. Rich NM, Collins GJ, Andersen CA, McDonald PT. Autogenous venous interposition grafts in repair of major venous injuries. J Trauma. 1977;17:512–520
  87. Fox CJ, Gillespie DL, O'Donnell SD, Rasmussen TE, Goff JM, Johnson CA, et al. Contemporary management of wartime vascular trauma. J Vasc Surg. 2005;41:638–644
  88. Fox CJ, Starnes BW. Vascular surgery on the modern battlefield. Surg Clin North Am. 2007;87:1193–1211xi
  89. Emergency War Surgery, 3rd United States Revision. Washington, DC: Department of Defense through the Borden Institute and Walter Reed Army Medical Center; 2004;
  90. Carrel A. Landmark article, Nov 14, 1908: Results of the transplantation of blood vessels, organs and limbs. JAMA. 1983;250:944–953
  91. Timberlake GA, O'Connell RC, Kerstein MD. Venous injury: to repair or ligate, the dilemma. J Vasc Surg. 1986;4:553–558
  92. Timberlake GA, Kerstein MD. Venous injury: to repair or ligate, the dilemma revisited. Am Surg. 1995;61:139–145
  93. Hobson RW, Howard EW, Wright CB, Collins GJ, Rich NM. Hemodynamics of canine femoral venous ligation: significance in combined arterial and venous injuries. Surgery. 1973;74:824–829
  94. Barcia PJ, Nelson TG, Whelan TJ. Importance of venous occlusion in arterial repair failure: an experimental study. Ann Surg. 1972;175:223–227
  95. Nypaver TJ, Schuler JJ, McDonnell P, Ellenby MI, Montalvo J, Baraniewski H, et al. Long-term results of venous reconstruction after vascular trauma in civilian practice. J Vasc Surg. 1992;16:762–768
  96. Pappas PJ, Haser PB, Teehan EP, Noel AA, Silva MB, Jamil Z, et al. Outcome of complex venous reconstructions in patients with trauma. J Vasc Surg. 1997;25:398–404
  97. Sharma PV, Shah PM, Vinzons AT, Pallan TM, Clauss RH, Stahl WM. Meticulously restored lumina of injured veins remain patent. Surgery. 1992;112:928–932
  98. Nypaver TJ, Schuler JJ, McDonnell P, Ellenby MI, Montalvo J, Baraniewski H, et al. Long-term results of venous reconstruction after vascular trauma in civilian practice. J Vasc Surg. 1992;16:762–768
  99. Bermudez KM, Knudson MM, Nelken NA, Shackleford S, Dean CL. Long-term results of lower-extremity venous injuries. Arch Surg. 1997;132:963–967
  100. Mullins RJ, Lucas CE, Ledgerwood AM. The natural history following venous ligation for civilian injuries. J Trauma. 1980;20:737–743
  101. Rich NM, Jarstfer BS, Geer TM. Popliteal artery repair failure: causes and possible prevention. J Cardiovasc Surg (Torino). 1974;15:340–351
  102. Rich NM. Principles and indications for primary venous repair. Surgery. 1982;91:492–496
  103. The Polytrauma Patient. In:  Stannard JP,  Schmidt AH,  Kregor PJ editor. Surgical Treatment of Orthopaedic Trauma. New York: Thieme; 2007;p. 852–875
  104. Okike K, Bhattacharyya T. Trends in the management of open fractures (A critical analysis). J Bone Joint Surg Am. 2006;88:2739–2748
  105. Pape HC, Tscherne H. Early definitive fracture fixation, pulmonary function and systemic effects. In:  Baue AE,  Faist E,  Fry M editor. Multiple Organ Failure. New York: Springer Verlag; 2000;p. 279–290
  106. Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma. 2005;19:551–562
  107. Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma. 1994;37:667–672
  108. McKeague A, Arnaud F, Tomori T, Saito R, Prusaczyk WK, McCarron RM. Evaluation of Bagged and Powdered Formulations of Zeolite Hemostatic Agent (QuikClot). Abstract obtained at 1st International Miltranet Symposium, Koblenz, Germany, May 2006.
  109. Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma. 1996;40:17–21
  110. McHenry TP, Holcomb JB, Aoki N, Lindsey RW. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma. 2002;53:717–721
  111. Camuso MR. Far-forward fracture stabilization: external fixation versus splinting. J Am Acad Orthop Surg. 2006;14:S118–S123
  112. Watson JT. Principals of external fixation. In:  Bucholtz RW,  Heckman JD,  Court-Brown CM editor. Rockwood and Green's Fractures in Adults. 6th ed.. Philadelphia: Lippincott Williams and Wilkins; 2006;
  113. Ertl W, Henley MB. Provisional external fixation for periarticular fractures of the tibia. Tech Orthop. 2002;12:135–144
  114. Gardner MJ, Mehta S, Barei DP, Nork SE. Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss. J Ortho Trauma. 2008;22:451–457
  115. Ilizarov GA. Transosseous Osteosynthesis. Berlin: Springer Verlag; 1992;
  116. Reudi TP, Buckley C, Moran KA. AO Principles of Fracture Management. New York, Stuttgart: Thieme; 2007;
  117. Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br. 2000;82:959–966
  118. Higgins T, Templeman DC. Fractures of the Tibial Diaphysis [Trauma 3] (Orthopedic Knowledge Update). Rosemont, IL: AAOS; 2005;
  119. Bhandari M, Guyatt G, Tornetta P, Schemitsch EH, Swiontkowski M, Sanders D, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90:2567–2578
  120. Schemitsch EH, Kowalski MJ, Swiontkowski MF, Senft D. Cortical bone blood flow in reamed and unreamed locked intramedullary nailing: a fractured tibia model in sheep. J Orthop Trauma. 1994;8:373–382
  121. Court-Brown CM. Fractures of the tibia and fibula. In:  Buckoltz RW,  Heckman JD,  Court-Brown CM editor. Rockwood and Green's Fractures in Adults. 6th ed.. Philadelphia: Lippincott Williams & Wilkins; 2006;
  122. Mack AW, Helgeson MD, Tis JE. Contralateral structural femoral autograft use in treatment of an open periarticular knee fracture to perform knee arthrodesis. J Orthop Trauma. 2008;22:576–580
  123. Sherman R, Rahban S, Pollak AN. Timing of wound coverage in extremity war injuries. J Am Acad Orthop Surg. 2006;14:S57–S61
  124. Gorman PW, Barnesa CL, Fischer TJ, McAndrew MP, Moore MM. Soft-tissue reconstruction in severe lower extremity trauma (A review). Clin Orthop. 1989;57–64
  125. Feliciano DV. Heroic procedures in vascular injury management: the role of extra-anatomic bypasses. Surg Clin North Am. 2002;82:115–124
  126. Feliciano DV, Herskowitz K, O'Gorman RB, Cruse PA, Brandt ML, Burch JM, et al. Management of vascular injuries in the lower extremities. J Trauma. 1988;28:319–328
  127. Covey DC. Combat orthopaedics: a view from the trenches. J Am Acad Orthop Surg. 2006;14:S10–S17
  128. Peck MA, Clouse WD, Cox MW, Bowser AN, Eliason JL, Jenkins DH, et al. The complete management of extremity vascular injury in a local population: a wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq. J Vasc Surg. 2007;45:1197–1204
  129. Khouri RK, Sherman R, Buncke HJ, Feller AM, Hovius S, Benes CO, et al. A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery. Plast Reconstr Surg. 2001;107:408–415
  130. Russell RC, Neumeister MW, Ostric SA, Engineer NJ. Extremity reconstruction using nonreplantable tissue (“spare parts”). Clin Plast Surg. 2007;34:211–222viii
  131. Younger AS, Goetz T. Soft tissue coverage for posttraumatic reconstruction. Foot Ankle Clin. 2006;11:217–235xi
  132. Levin LS. New developments in flap techniques. J Am Acad Orthop Surg. 2006;14:S90–S93
  133. Kumar AR. Standard wound coverage techniques for extremity war injury. J Am Acad Orthop Surg. 2006;14:S62–S65
  134. Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. J Orthop Trauma. 2007;21:70–76
  135. Lange RH, Bach AW, Hansen ST, Johansen KH. Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma. 1985;25:203–208
  136. Bosse MJ, McCarthy ML, Jones AL, Webb LX, Sims SH, Sanders RW, et al. The insensate foot following severe lower extremity trauma: an indication for amputation?. J Bone Joint Surg Am. 2005;87:2601–2608
  137. Mubarak SJ, Owen CA. Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Joint Surg Am. 1977;59:184–187
  138. Rorabeck CH, Clarke KM. The pathophysiology of the anterior tibial compartment syndrome: an experimental investigation. J Trauma. 1978;18:299–304
  139. Place RJ, Rush RM, Arrington ED. Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation Enduring Freedom. Curr Surg. 2003;60:418–422
  140. Rush RM, Stockmaster NR, Stinger HK, Arrington ED, Devine JG, Atteberry L, et al. Supporting the Global War on Terror: a tale of two campaigns featuring the 250th Forward Surgical Team (Airborne). Am J Surg. 2005;189:564–570
  141. Azar F. Traumatic disorders. In:  Canale S,  Beaty J editor. Campbell's Operative Orthopedics. Philadelphia: Mosby Elsevier; 2007;p. 2737–2746
  142. Gelberman RH, Garfin SR, Hergenroeder PT, Mubarak SJ, Menon J. Compartment syndromes of the forearm: diagnosis and treatment. Clin Orthop. 1981;252–261
  143. Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg. 2002;89:397–412
  144. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures (The pressure threshold for decompression). J Bone Joint Surg Br. 1996;78:99–104
  145. Gentilello LM, Sanzone A, Wang L, Liu PY, Robinson L. Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function. J Trauma. 2001;51:1–8discussion
  146. Giannotti G, Cohn SM, Brown M, Varela JE, McKenney MG, Wiseberg JA. Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome. J Trauma. 2000;48:396–399
  147. Arbabi S, Brundage SI, Gentilello LM. Near-infrared spectroscopy: a potential method for continuous, transcutaneous monitoring for compartmental syndrome in critically injured patients. J Trauma. 1999;47:829–833
  148. Cohen MS, Garfin SR, Hargens AR, Mubarak SJ. Acute compartment syndrome (Effect of dermotomy on fascial decompression in the leg). J Bone Joint Surg Br. 1991;73:287–290
  149. Pearse MF, Harry L, Nanchahal J. Acute compartment syndrome of the leg. BMJ. 2002;325:557–558
  150. Lappalainen H, Tiula E, Uotila L, Manttari M. Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: implications for follow-up. Crit Care Med. 2002;30:2212–2215
  151. Brown CV, Rhee P, Chan L, Evans K, Demetriades D, Velmahos GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?. J Trauma. 2004;56:1191–1196
  152. Sever MS, Erek E, Vanholder R, Lameire N. Effect of gender on various parameters of crush syndrome victims of the Marmara earthquake. J Nephrol. 2004;17:399–404
  153. Atef MR, Nadjatfi I, Boroumand B, Rastegar A. Acute renal failure in earthquake victims in Iran: epidemiology and management. Q J Med. 1994;87:35–40
  154. Morris JA, Mucha P, Ross SE, Moore BF, Hoyt DB, Gentilello L, et al. Acute posttraumatic renal failure: a multicenter perspective. J Trauma. 1991;31:1584–1590
  155. Oda J, Tanaka H, Yoshioka T, Iwai A, Yamamura H, Ishikawa K, et al. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470–475
  156. Briggs SM, Brinsfield KH. Advanced Disaster Medical Response (Manual for Providers). Boston: Harvard Medical International; 2003;
  157. Gupta A, Shatford RA, Wolff TW, Tsai TM, Scheker LR, Levin LS. Treatment of the severely injured upper extremity. Instr Course Lect. 2000;49:377–396
  158. Potter BK, Burns TC, Lacap AP, Granville RR, Gajewski D. Heterotopic ossification in the residual limbs of traumatic and combat-related amputees. J Am Acad Orthop Surg. 2006;14:S191–S197
  159. Potter BK, Burns TC, Lacap AP, Granville RR, Gajewski DA. Heterotopic ossification following traumatic and combat-related amputations (Prevalence, risk factors, and preliminary results of excision). J Bone Joint Surg Am. 2007;89:476–486
  160. Kaplan FS, Glaser DL, Hebela N, Shore EM. Heterotopic ossification. J Am Acad Orthop Surg. 2004;12:116–125
  161. Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br. 2004;86:783–787
  162. Horne LT, Blue BA. Intraarticular heterotopic ossification in the knee following intramedullary nailing of the fractured femur using a retrograde method. J Orthop Trauma. 1999;13:385–388
  163. Mills WJ, Tejwani N. Heterotopic ossification after knee dislocation: the predictive value of the injury severity score. J Orthop Trauma. 2003;17:338–345
  164. Schafer SJ, Schafer LO, Anglen JO, Childers M. Heterotopic ossification in rehabilitation patients who have had internal fixation of an acetabular fracture. J Rehabil Res Dev. 2000;37:389–393
  165. Schmidt AH, Templeman DC, Grabowski CM. Antegrade intramedullary nailing of the humerus complicated by heterotopic ossification of the deltoid: a case report. J Orthop Trauma. 2001;15:69–73
  166. Stannard JP, Wilson TC, Sheils TM, McGwin G, Volgas DA, Alonso JE. Heterotopic ossification associated with knee dislocation. Arthroscopy. 2002;18:835–839
  167. Haran M, Bhuta T, Lee B. Pharmacological interventions for treating acute heterotopic ossification. Cochrane Database Syst Rev. 2004;CD003321
  168. Barthel T, Baumann B, Noth U, Eulert J. Prophylaxis of heterotopic ossification after total hip arthroplasty: a prospective randomized study comparing indomethacin and meloxicam. Acta Orthop Scand. 2002;73:611–614
  169. Legenstein R, Bosch P, Ungersbock A. Indomethacin versus meloxicam for prevention of heterotopic ossification after total hip arthroplasty. Arch Orthop Trauma Surg. 2003;123:91–94
  170. Chao ST, Lee SY, Borden LS, Joyce MJ, Krebs VE, Suh JH. External beam radiation helps prevent heterotopic bone formation in patients with a history of heterotopic ossification. J Arthroplasty. 2006;21:731–736
  171. Chao ST, Joyce MJ, Suh JH. Treatment of heterotopic ossification. Orthopedics. 2007;30:457–464
  172. Champion HR, Bellamy RF, Roberts CP, Leppaniemi A. A profile of combat injury. J Trauma. 2003;54:S13–S19
  173. Trunkey DD, Ochsner MG. Management of battle casualties. In:  Feliciano DV,  Mattox KL,  Moore EE editor. Trauma. Stamford, CT: Appleton and Lange; 1996;p. 1023–1035
  174. Rush RM, Kjorstad R, Starnes BW, Arrington E, Devine JD, Andersen CA. Application of the mangled extremity severity score in a combat setting. Mil Med. 2007;172:777–781
  175. Owens BD, Kragh JF, Macaitis J, Svoboda SJ, Wenke JC. Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2007;21:254–257
  176. Owens BD, Kragh JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64:295–299
  177. Brodie S, Hodgetts TJ, Ollerton J, McLeod J, Lambert P, Mahoney P. Tourniquet use in combat trauma: UK military experience. J R Army Med Corps. 2007;153:310–313
  178. Kragh JF, Baer DG, Walters TJ. Extended (16-hour) tourniquet application after combat wounds: a case report and review of the current literature. J Orthop Trauma. 2007;21:274–278
  179. Mabry RL. Tourniquet use on the battlefield. Mil Med. 2006;171:352–356
  180. Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, et al. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. J Trauma. 2008;64:1093–1099
  181. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma. 2006;60:655–658
  182. Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77:761–777
  183. Wolf YG, Rivkind A. Vascular trauma in high-velocity gunshot wounds and shrapnel-blast injuries in Israel. Surg Clin North Am. 2002;82:237–244
  184. Ritenour AE, Dorlac WC, Fang R, Woods T, Jenkins DH, Flaherty SF, et al. Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma. 2008;64:S153–S161
  185. Brounts LR, Wickel D, Arrington ED, Place RJ, Rush RM. The use of a temporary intraluminal shunt to restore limb perfusion over a 4,000 mile air evacuation in a special operations military setting: a case report. Clin Med Trauma Intensive Med. 2008;1:5–9

PII: S0011-3840(09)00072-0

doi: 10.1067/j.cpsurg.2009.05.003

Current Problems in Surgery
Volume 46, Issue 11 , Pages 851-926 , November 2009

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