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Salavage of Crushed Limbs
With the increase in high tech industries, high velocity trauma and crimes limb injuries are becoming more common and much more extensive. Many times limbs are severely crushed and in a state of near total amputation. Hand or foot are hanging on skin tag. Sever crushing of part of limb with almost normal distal part. In such conditions we can salvage the limb. This condition is more commonly seen then total amputations. CRITERIA FOR REVASCULARISATION..Revascularisation means restoration of circulation.Although it is very difficult to make clear guide line for this. But I have made few points for re vascularisation.
  UPPER LIMB. Every attempt should be made to salvage. If segmental crushing is present then that segment can be excised and replant the rest of part of limb. So it is like clean amputation for replant.
  LOWER LIMB-Extensive crushing with proximal Neurovascular damage, below knee amputation can be preferred rather then major lower limb replantation. Every attempt should be made to salvage below knee amputed stump.If soft tissue is lacking for below knee stump then various flaps are available to reconstruct stump.
  Segmental crushing in lower half of leg with normal ankle, excision of segment and replant of limb can be done provided shortening is not more then 4 inches. Although criteria of 4 inches is controversial as more then this shortening in a young boy in latter stage can be corrected by various lengthening proc3edures.
  Try to salvage sensory foot.
  Proximal lower limb replant in elderly can be avoided.

BONE----see for fractures. Digital X-ray gives better information.
CIRCULATION---Pulsations, capillary circulation.Venous refilling, temperature.
MOVEMENT-----Tendons, see movements at different joints.
NERVE------------Sensation, Motor examination.

PRIORITY OF MANAGEMENT..stabilization of fractures and restoration of circulation is priority followed by Repair of nerve and tendons and cover of wound either by graft or flap. Removal of all necrotic tissue is very important for salvage of crushed limb. All important structures like Neurovascular structures,tendons and bone should be covered by flap as early as possible.

CASE V-His upper limb got crushed in a machine leading to near total amputation at elbow. Re-vascularisation done after three inches shortening. Good function returned after 12 months.
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