The mangled upper extremity: a principled approach to management

A mangled upper extremity often involves injury to soft tissue, bone, nerves, and vessels and presents a unique challenge to hand surgeons. The complexity of such injuries requires a multidisciplinary approach to achieve an optimal functional outcome. After obtaining a thorough history and performing a secondary survey, initial management is built upon a strong understanding of the likelihood of limb salvage. Initiation of antibiotics upon presentation, timely and thorough surgical debridement, and early revascularization efforts should be pursued. The surgical team should create a long-term plan involving skeletal stabilization and soft tissue reconstruction along with postoperative rehabilitation and social support. This article reviews current concepts of upper extremity limb salvage and recommendations for surgical management of the mangled extremity.