The Mangled Extremity: An Update

The purpose of this article is to explore the changes over the last 10 years related to limb salvage for even the most complex cases of limb trauma and describe a thoughtful approach to the mangled extremity. CT angiography has replaced formal angiography around the country with promising results for evaluating the vascular network of a limb. While concepts in skeletal fixation and vascular reconstruction have remained generally unchanged, advances in nerve grafting and conduit use will guide future directions for limb salvage and improve functional outcomes for patients. The surgeon should consider the analogies of home building and limb salvage when planning their reconstructive steps: image review as blueprints, debridement as foundation excavation, skeletal fixation as the foundation and framework, plumbing and electric as vessel and nerve repair, and soft tissue coverage as the roof above the reconstruction.