Uncommon Mechanism of Mangled Lower Limb Trauma: Case Report of Salvaged Leg Post Gear Box Explosion Injury

Mangled limb injuries, typically caused by high-energy trauma, present significant challenges in surgical decision-making, particularly when considering limb salvage versus primary amputation. While common mechanisms include vehicular or industrial accidents, unconventional etiologies are rarely documented. We report a unique case of a 43-year-old female who sustained a mangled left lower limb injury following a gearbox explosion in a Porsche Cayenne. The injury resulted in a near-complete amputation at the distal third of the leg, with extensive contamination by oily and metallic debris. Radiologic assessment confirmed complex fractures and vascular injury, with transection of the posterior tibial and peroneal arteries. Despite a high Mangled Extremity Severity Score (MESS) of 7 and initial surgical consensus favoring below-knee amputation, the patient and her family strongly advocated for limb preservation. The initial management involved damage control surgery with extensive debridement and external fixation. A multidisciplinary team provided staged reconstruction despite significant soft tissue loss and neurological deficits. The patient demonstrated favorable vascular recovery and maintained foot viability, ultimately preserving the limb. This case highlights an unusual mechanism of mangled limb trauma and underscores the critical role of shared decision-making in trauma care. It reinforces that, in carefully selected patients, limb salvage may be feasible even in scenarios traditionally warranting amputation.