Management Strategies for Patients With Multiple Extremity Necrosis Following Life-Sustaining Vasosupportive...

The patient with four-extremity necrosis and amputations following intensive care unit care with vasopressor agents has many differences from the patient with digital necrosis from peripheral vascular disease or from the patient with a mutilating hand injury who has an opposite normal upper extremity. Preservation of as much residual amputation length is especially important. Local vascularized flaps may be possible in these patients to maximize length preservation, but are not possible in patients with peripheral vascular disease. Future function with prostheses is as important as when not wearing a prosthesis, since the patient spends most of the time actually not wearing prostheses. Technology can be leveraged in favor of additional assistance for these patients, not least of which is 3-dimensional printing for making tenodesis prostheses where the more proximal mobile joint powers distal function. 3-dimensional printing enables less expensive prosthesis fitting for the life of the patient. The reconstructive surgeon must have a vision for the future functional goals of the patient, especially when using available residual digits to create the most functional prehensile hand with the goal of achieving independence in mobility, eating, and toileting.