Western Trauma Association Critical Decisions in Trauma: Management of the mangled extremity

Thomas M. Scalea, Joseph DuBose, Ernest E. Moore, Michael West, Frederick A. Moore, Robert McIntyre, Christine S Cocanour, James Davis, M. Gage Ochsner, David Feliciano

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


BACKGROUND: The operative management of mangled extremities after trauma remains controversial. We have sought to develop an evidencebased algorithm to help guide practitioners when faced with these relatively infrequent but very challenging clinical dilemmas. METHODS: The Western Trauma Association Critical Decisions Committee queried the literature to identify high-quality managements that would help guide the care of mangled extremities. When good data were not available, the Committee relied on expert opinions, either from the literature or from our senior members. RESULTS: Virtually, all the scoring systems used to guide therapy have not been proven to be valid. Hemodynamically unstable patients who failed to respond to initial resuscitation should be taken to the operating room for exploration and vascular control. Those who are stable should undergo a stepwise vascular and neurologic evaluation process. A comprehensive evaluation of factors that may help predict the appropriateness of limb salvage should be done in the operating room. Patients who are not candidates for salvage should undergo primary amputation. Those who are should undergo attempts at limb salvage. CONCLUSIONS: Patients with mangled extremities remain a significant management challenge. This algorithm represents a guideline based on the best evidence available in the literature and expert opinion. It does not establish a standard of care. It should provide a framework for treating physicians and other healthcare professionals to guide therapy, considering individual patients' clinical status and institutional resources.

Original languageEnglish (US)
Pages (from-to)86-93
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Issue number1
StatePublished - Jan 2012


  • Amputation
  • Mangled extremity
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)


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