Salvage of Mangled Lower Extremity – Single Institution Experience

Background: Treatment of severe limb injuries remains controversial. Modern advances in resuscitation, free tissue transplantation, and fracture fixation have made these limbs salvageable although this is difficult and time-consuming. Various scoring systems have been proposed to predict the outcomes.

Objective: To describe our experience in salvaging mangled lower extremities at a tertiary care hospital. This Retrospective Cohort Study was conducted at the Department of Plastic Surgery Shifa International Hospital Islamabad Pakistan, from January, 2013 to December, 2022.

Methodology: All patients of either gender with the age range of 16 to 70 years, with mangled lower extremity who underwent limb salvage surgery, were included in this study. Radiological assessments were done preopera- tively using X-rays, CT scans, and angiograms if indicated. These patients were assessed using The Mangled Extremity Severity Score (MESS) to assess their eligibility for salvage. A maximum score of 15 was summed. A score of < 7 was used as predictive of salvage.

Results: A total of 60 patients underwent limb salvage during this 10 year period. A significant proportion of mangled lower extremities were successfully salvaged (78.3%), while 21.7% required subsequent amputation. In terms of the mechanism of injury, 60% of cases were attributed to Road Traffic Accidents (RTA), 18.3% to Falls, 15% to Gun Shots, and 6.7% to Bomb Blast. From the pedicled flaps group, the gastrocnemius was performed in most cases, comprising 15% of total reconstruction, followed by soleus (10%). Free Latissimus Dorsi (LD) flap was used as free tissue transfer in 21%, followed by Free Anterolateral thigh (ALT) flap (10%).

Conclusion: The overall salvage rate for mangled lower extremities in the study was 78.3%. This suggests that irrespective of gender or mechanism of injury, salvage procedures were generally successful in a significant majority of cases.

Keywords | Mangled Extremity, Salvage, Extremity reconstruction, Amputation

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