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Tibia Fractures Resulting in Amputation

- Discussion:
    - mangled extremity severity score:
    - main controversy is whether tibial defect reconstruction and soft tissue reconstruction are indicated;
    - indications:
         - high velocity open tibia frx, w/ concomitant nerve, artery, &/or massive soft tissue disruption;
         - types IIIB and IIIC tibial frx w/ assoc w/ insensate foot or major bony injuries;
         - open tibia fractures w/ severe comorbidity (elderly pt, renal failure ect);
         - infected non unions, skin necrosis, skin loss in elderly pt w/ comorbidity; 

- Management:
    - technique of below knee amputation 
    - prevent infection:
          - irrigation (w/ > 9 lit) and repeated debridment;
          - debridement of open tibia fractures
          - consider leaving the wound open, wound vac, w/ delayed closure at 3-5 days post-injury;
          - antibiotics
          - type II and III open frx repeat debridment is required to evaluate amount of devitalized & potentially necrotic soft tissue;
          - soft tissue coverage as soon as the wound is clean;
                 - skin grafting & free flaps are often required;
                 - STSG over bone is rarely successful;

- BKA Prosthesis:

- references: 

           - Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation: Preliminary Results of the Mangled Extremity Severity Score.
           - The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.

Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.

The severely traumatized lower limb: reconstruction versus amputation.  

Limb reconstruction versus amputation decision making in massive lower extremity trauma.

The function of below-knee amputee versus the patient with salvaged grade III tibial fracture.

Open Tibial Fractures with Severe Soft-Tissue Loss.  Limb Salvage Compared with Below-the-Knee Amputation.

Lower limb replantation. A report of nine cases.

The Insensate Foot Following Severe Lower Extremity Trauma: An Indication for Amputation?

To Reconstruct or Not to Reconstruct?

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.

Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.

Open tibia fracture: amputation versus limb salvage. Opinion: below-the-knee amputation.

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