The mangled extremity. Compartment syndrome and amputations.

Injuries that amputate, crush, or otherwise mangle an extremity are devastating. The possibilities of medical and psychologic disability, multiple operations, and protracted rehabilitation loom before these patients. Fortunately, expert care given by the emergency department physician maximizes the opportunity for success should the limb be replanted or revascularized. The first priority for the emergency department staff is the efficient and aggressive resuscitation of the patient. Only after this has been carried out and other life-threatening injuries addressed can attention be directed toward the injured limb. It is in the patient's best interest if the emergency department staff assumes that a mangled extremity will be replanted or revascularized. Advances in microsurgical technique and equipment have enabled surgeons to achieve salvage rates greater than 90%. Continued improvements in technique, equipment, rehabilitation, and patient selection will enable more patients to benefit from limb salvage procedures.