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[Management of severe soft-tissue trauma in the upper extremity - shoulder, upper and lower arm].

Abstract：

OBJECTIVE:Salvage of the respective extremity. Standardized approach to adequate soft-tissue coverage (isolated severe soft-tissue trauma) and preconditioning for fracture healing (in complex trauma) as a basis for functional restoration. Limitation of secondary soft-tissue loss. Prevention of infection. INDICATIONS:Isolated extended severe soft-tissue trauma (crush trauma, degloving injury) in the region of the shoulder and the upper extremity. Complex trauma with soft-tissue involvement Gustilo IIIB/C or Tscherne GIII/IV. Segmental soft-tissue/bone loss. Subtotal or partial amputations. CONTRAINDICATIONS:Unstable polytraumatized patient with vital hazards and the priority for lifesaving measures. Irretrievable devascularization or unreconstructable neural destruction, extended severe loss of multiple muscular units. SURGICAL TECHNIQUE:Systematic, eventually serial debridement, temporary joint transfixation, reconstruction of macrocirculation, dermatofasciotomy in compartment syndrome, preferably primary shortening in segmental soft-tissue/bone loss, temporary soft-tissue coverage, systematic conditioning of soft tissues, postprimary or secondary soft-tissue reconstruction, secondary change to preferably internal fixation techniques. POSTOPERATIVE MANAGEMENT:Individualized earliest possible passive or assisted mobilization of nontransfixed joints, early removal of transfixation and change to internal fixation modes, eventually secondary reconstructive measures (e.g., augmentation of bone defects, flap correction, secondary nerve reconstruction, functional muscle transposition procedures, arthrolyses). RESULTS:Patency rate after vascular reconstruction > 90%, flap survival > 95%, need for amputation is a rare entity; main determinants of prognosis: severity of soft-tissue trauma, neural damage, and potential for reconstruction.

journal_name

Oper Orthop Traumatol

journal_title

Operative Orthopadie und Traumatologie

authors

Mittlmeier T,Krapohl BD,Schaser KD

doi

10.1007/s00064-010-8045-6

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

196-211

issue

2

eissn

0934-6694

issn

1439-0981

journal_volume

22

pub_type

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