Management of extremity with combined neurovascular and musculoskeletal trauma

Twenty-five civilians with combined neurovascular and musculo-skeletal trauma to 27 extremities were studied retrospectively. The mechanism of injury was crushing in 16, avulstion in six, and penetrating in three. Autogenous saphenous vein was used to restore arterial circulation in the majority. Nine patients had concurrent repair of venous injuries. Fractures were immobilized by a variety of techniques, the Hoffman external skeletal fixation being preferred. Immediate fasciotomy was performed in five patients and delayed fasciotomy in four. All patients had soft-tissue debridement and initial wound closure with split-skin grafts as biologic dressings. Three immediate amputations were the result of irreversible neurovascular and soft-tissue trauma. Sepsis played a role in three late amputations; delayed primary treatment,, irreversible neurologic injuries and extensive soft-tissue damage contributed. A carefully individualized multidisciplinary approach resulted in salvage of 20 of 27 severely injured extremities.