Kratko priopćenje
Mangled Extremity – Case Report, Literature Review and Borderline Cases Guidelines Proposal
Bore Bakota
; Karlovac General Hospital, Department of Traumatology, Karlovac, Croatia
Mario Kopljar
; University of Zagreb, Dubrava University Hospital, Department of Surgery, Zagreb, Croatia
Zoran Jurjevic
; Karlovac General Hospital, Department of Radiology, Karlovac, Croatia
Mario Staresinic
; University of Zagreb, »Merkur« University Hospital, Department of Surgery, Zagreb, Croatia
Ivan Cvjetko
; University of Zagreb, »Merkur« University Hospital, Department of Surgery, Zagreb, Croatia
Ivan Dobric
; University of Zagreb, Zagreb University Hospital Center, Department of Traumatology, Zagreb, Croatia
Diarmuid De Faoite
; AO Clinical Investigation and Documentation, Dübendorf, Switzerland
Sažetak
Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled
extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion,
reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation.
Ključne riječi
limb salvage; amputation; lower extremity; leg injuries; decision making; ankle injuries; foot injuries; MESS; mangled lower extremities; VAC
Hrčak ID:
94992
URI
Datum izdavanja:
27.12.2012.
Posjeta: 1.577 *