Mangled extremity: limb salvage for reconstruction versus primary amputation.
Journal
Current opinion in critical care
ISSN: 1531-7072
Titre abrégé: Curr Opin Crit Care
Pays: United States
ID NLM: 9504454
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
2
11
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
ppublish
Résumé
While MESS has historically influenced limb salvage versus amputation decisions, its universal applicability remains uncertain. With trauma systems expanding and advancements in trauma care, the need for a nuanced understanding of limb salvage has become paramount. Recent literature reflects a shift in the management of mangled extremities. Vascular surgery, plastic surgery, and technological advancements have garnered attention. The MESS's efficacy in predicting amputation postvascular reconstruction has been questioned. Machine learning techniques have emerged as a means to predict peritraumatic amputation, incorporating a broader set of variables. Additionally, advancements in socket design, such as automated adjustments and bone-anchored prosthetics, show promise in enhancing prosthetic care. Surgical strategies to mitigate neuropathic pain, including targeted muscle reinnervation (TMR), are evolving and may offer relief for amputees. Predicting the long-term course of osteomyelitis following limb salvage is challenging, but it significantly influences patient quality of life. The review underscores the evolving landscape of limb salvage decision-making, emphasizing the need for personalized, patient-centered approaches. The Ganga Hospital Score (GHS) introduces a nuanced approach with a 'grey zone' for patients requiring individualized assessments. Future research may leverage artificial intelligence (AI) and predictive models to enhance decision support. Overall, the care of mangled extremities extends beyond a binary choice of limb salvage or amputation, necessitating a holistic understanding of patients' injury patterns, expectations, and abilities for optimal outcomes.
Identifiants
pubmed: 37909372
doi: 10.1097/MCC.0000000000001108
pii: 00075198-202312000-00024
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
682-688Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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