Severe Injuries to the Limbs:Staged Treatment

Modern weapons and high-energy accidents inflict devastating damage
to soft tissue and bone. The gold standard for stabilizing high-
energy fractures is immediate external fixation followed by thorough
debridement of soft tissues and dead bone and irrigation, since these
injuries are always grossly contaminated. The next stage of
treatment ? the coverage of exposed bone by vital soft tissue and
definitive skeletal stabilization and reconstruction ? can be a
complex surgical challenge. The protocol of staged external fixation
developed by the authors: primary temporary unilateral tubular
stabilization followed by definitive circular Ilizarov (hybrid)
fixation, is outlined and comprehensively described in this book. The
text provides guidelines for the young surgeon as well as the senior
orthopedic trauma surgeon in staged definitive limb functional
reconstruction. The rationale and advantages of a logical progression
of surgical steps are explained and fully illustrated throughout,
drawing from an archive of clinical photographs and X-ray
documentation covering all steps of the treatment protocol in a large
variety of complex cases, including extensive bone and soft tissue
loss. This practical guide is based on the accumulated experience of
40 years in the treatment of severe injuries of the musculoskeletal
system with grave tissue loss, and in particular war injuries.
Emphasis is given to the proper attention and care of the soft
tissues, sequential damage control, and the judicious staged use of
appropriate external fixation.