The Mangled Extremity: An Update

  • Alexander J. KishEmail author
  • Raymond A. Pensy
Trauma Surgery (J. Diaz, Section Editor)
Part of the following topical collections:
  1. Trauma Surgery


Purpose of Review

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.

Recent Findings

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.


Mangled extremity Reconstruction Freeflap Trauma 


Compliance with Ethical Guidelines

Conflict of interest

Alexander J. Kish and Raymond A. Pensy declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40137_2019_226_MOESM1_ESM.docx (1.8 mb)
Supplementary material 1 (DOCX 1751 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsR Adams Cowley Shock Trauma CenterBaltimoreUSA

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