# Limb salvage

Limb salvage

The Mangled Extremity Severity Score (MESS) and its modi - fications are useful in deciding about limb salvage. Extensive tissue loss, neurovascular damage and loss of  long fragments of bone are traditionally indications for amputation. Curr ently , wounds of any dimension can be covered with microvascular flaps and distraction osteogenesis and vascularised bone can be used to restore bony continuity . If performed in time, vascular repairs can salvage most acutely ischaemic limbs. Because of  these developments the indications for amputation in trauma have undergone a paradigm shift and the majority of  patients who reach a tertiary-care facility within 24 hours are candidates for limb salvage ( Figure 33.13 ). This assumes ·0.5H O, which sets hard when water is added to it. 4 2 that debridement and, if  required, vascular repairs have been performed in a field medical facility . A limb is unlikely to survive if  the vascular repair of  major limb vessels has been delayed for more than 4–6 hours. 

(c)
Figure 33.13
(a–d)
Badly traumatised lower limb. Reconstruction has been performed using a microvascular rectus abdominis
/f_l
ap covered
with a skin graft.

Limb salvage

The Mangled Extremity Severity Score (MESS) and its modi - fications are useful in deciding about limb salvage. Extensive tissue loss, neurovascular damage and loss of  long fragments of bone are traditionally indications for amputation. Curr ently , wounds of any dimension can be covered with microvascular flaps and distraction osteogenesis and vascularised bone can be used to restore bony continuity . If performed in time, vascular repairs can salvage most acutely ischaemic limbs. Because of  these developments the indications for amputation in trauma have undergone a paradigm shift and the majority of  patients who reach a tertiary-care facility within 24 hours are candidates for limb salvage ( Figure 33.13 ). This assumes ·0.5H O, which sets hard when water is added to it. 4 2 that debridement and, if  required, vascular repairs have been performed in a field medical facility . A limb is unlikely to survive if  the vascular repair of  major limb vessels has been delayed for more than 4–6 hours. 

(c)
Figure 33.13
(a–d)
Badly traumatised lower limb. Reconstruction has been performed using a microvascular rectus abdominis
/f_l
ap covered
with a skin graft.

Limb salvage

The Mangled Extremity Severity Score (MESS) and its modi - fications are useful in deciding about limb salvage. Extensive tissue loss, neurovascular damage and loss of  long fragments of bone are traditionally indications for amputation. Curr ently , wounds of any dimension can be covered with microvascular flaps and distraction osteogenesis and vascularised bone can be used to restore bony continuity . If performed in time, vascular repairs can salvage most acutely ischaemic limbs. Because of  these developments the indications for amputation in trauma have undergone a paradigm shift and the majority of  patients who reach a tertiary-care facility within 24 hours are candidates for limb salvage ( Figure 33.13 ). This assumes ·0.5H O, which sets hard when water is added to it. 4 2 that debridement and, if  required, vascular repairs have been performed in a field medical facility . A limb is unlikely to survive if  the vascular repair of  major limb vessels has been delayed for more than 4–6 hours. 

(c)
Figure 33.13
(a–d)
Badly traumatised lower limb. Reconstruction has been performed using a microvascular rectus abdominis
/f_l
ap covered
with a skin graft.