Limb salvage procedures for mangled lower extremities: How I do it

Abstract

Majority of open fractures in Nigeria result from road Traffic Accident (RTA). This is partly due to bad roads and reckless use of motor cycles as the main means of intra-city transport. (Udosen, et al, 2004; Udosen, AM, Ugare G, 2005) These are precarious injuries associated with severe complications leading to amputation. This procedure devised by the authors was designed to reduce these complications, particularly because amputation is not yet acceptable in our environment, where ignorance, poverty and stigmatization are common. This procedure is simple and cheap and has a satisfactory result in an environment of limited resources. The study was done at the University of Calabar teaching hospital within a period of 6years. 62 limbs in 60 patients were salvaged using this  procedure at an average of about 10 salvaged limbs per year. 66% (41) of them had regained full function while 28% (17) were still undergoing various forms of rehabilitations. 6% (4) had amputation because of flail limbs and or severe infections. Male: female ratio was 4:1 and the average age was 32years (17-52yrs). All the injuries were caused by road traffic accident and 60% of this were due to motor cycle accidents. The average mangled extremity severity score (MESS) for the injured limbs was 4.5 (3-7). Complications encountered in the study included pin tract infection 58%,wound infection 26%,Chronic osteomyelitis 12%,gross deformity and flail limb 6%,graft failure 6%, Chronic pain 4% Improvement on this method requires adequate funding and provision of necessary equipment as well as training of personnel.

KEYWORDS: Mangled extremity, limb salvage, Ignorance, Debridement