Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Systemic
Abstract number: 26119
THE PROPOSAL OF NEW CLASSIFICATION AND TREATMENT PROTOCOL
FOR SEGMENTAL DESTRUCTIVE LIMB INJURIES WITH INTACT DISTAL PART
Cedomir VUCETIC, Goran TULIC, Borislav DULIC, Cedo VUCKOVIC, Aleksandar
TODOROVIC
Institute for orthopaedic surgery and traumatology, Belgrade (SERBIA)
A segmental destructive limb injury with intact distal part represents quite a challenge
for a surgeon if a limb salvage procedure is intended. We have encountered two
major types and two subtypes of these injuries. Type A injuries are transversal
destructions whilst type B are longitudinal segmental destructions. We divided these
major two types in two additional subtypes each: A1-transverse segmental soft tissue
destruction without any bone involvement; A2 transverse segmental destruction
involving bone; B1 longitudinal segmental soft tissue destruction without bone
involvement, and B2 longitudinal segmental destruction with bones involved. The
rational concept for treatment protocol for type A injuries would be to debride soft
tissues and shorten the bone as needed in order to achieve contact between
preserved parts of the limb. Type B injuries require extensive debridement and
reconstruction of soft tissue defect with composite flap while preserving the bone
length if possible. If not, the bone may be shortened initially, with elongation
procedures performed when the soft tissues sufficiently recover. This approach
shorten now, elongate later should be reserved as salvage procedure only for the
most severe injuries. In our experience shortening of up to 5 cm on forearm and
upper arm does not significantly impair limb function and appearance, which makes a
subsequent elongation optional. Treatment based on this classification and its
rational enables improved limb survival, wound and fracture healing, better infection
control and earlier rehabilitation. We feel that the functional and esthetic outcome in
patients with these injuries completely justifies described approach.
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