Management of Mutilating Upper Extremity Injuries

Question 1

Criteria for considering amputation

Answer 1

• Open fractures with large soft-tissue defect
• Warm ischemia time longer than 6 hours with muscle involvement
  ■ Proximal major nerve injury (e.g., brachia] plexus involvement)
• Unstable patient
• Older patient
• Associated major organ trauma
  ■ Comorbid medical problems with increased risk with prolonged
  anesthesia (e.g., myocardial infarction, stroke)

Question 2

Mangled Extremity Severity Score of seven or higher has been used as a cutoff to perform amputation

Answer 2

T but this has not
been validated in the upper extremity

Question 3

should not place the amputated part directly on ice to avoid
freezing of the tissues and frostbite injury

Answer 3

T

Question 4

6 hours for a warm extremity, 12 hours for a cold
extremity, 12 hours for a warm digit, and 24 hours for a cold digit

Answer 4

T

Question 5

As compared with digits, upper extremities have shorter ischemia times why?

Answer 5

because of degradation of deoxygenized muscle

Question 6

Debridement may be performed in the
immediate or delayed setting depending on the stability of the patient
and availability of a reconstructive surgeon

Answer 6

T

Question 7

The first debridement removes necrotic tissue and infectious burden, permitting adequate time for demarcation of nonviable tissues. 1

Answer 7

T

Question 8

Presence of a peripheral pulse may not exclude impending arterial compromise

Answer 8

T

Question 9

. Ischemia reperfusion injury consequences

Answer 9

decreased viability of the extremity, multiple organ failure syndrome,
and acute respiratory distress syndrome

Question 10

degree
of displacement and ability to maintain fracture reduction plays a
substantial role in surgical management

Answer 10

T

Question 11

more extensive soft-tissue injuries were associated with higher
infection and amputation rates

Answer 11

T

Question 12

Plating systems require
wide undermining of the periosteum for appropriate exposure and
placement, which may compromise the vascular supply to the bone

Answer 12

T

Question 13

plates and screw provide rigid fixation for earlier mobilization.

Answer 13

T

Question 14

the ultimate goals are initiation of range of motion
to provide improved function and minimization of soft tissue stripping to achieve bony healing and union of the fracture

Answer 14

T

Question 15

there are multiple tendons lacerated in zone 5, the tedious epitendinous sutures are often
not performed to expedite the surgical sequence because of the relative lack of restrictive adhesion formation in this zone

Answer 15

T

Question 16

Pulley reconstruction in mutilating upper extremity injuries should be performed always

Answer 16

F if multiple digits are involved

Question 17

The ribbon
sign has been used to identify areas of arterial vessel wall avulsion and
intimal injury and confers a poor prognosis for replantation

Answer 17

T

Question 18

Areas
with the ribbon sign should be debrided both proximallyand distally and the gap created should be bridged by a vein graft

Answer 18

T

Question 19

more extensive vascular
reconstruction, such as the palmar arch what type of graft we need ?

Answer 19

a Y-vein graft from the volar forearm is used to perform endto-end anastomoses to reconstruct multiple common digital arteries
concurrently

Question 20

preferable to perform the nerve
repair outside the zone of injury to ensure success.

Answer 20

T

Question 21

Indications for the use of conduits

Answer 21

nerve
gaps of less than 3 cm, nerves that are of small diameter, and noncritical, typically sensory nerves

Question 22

Nerve conduits have been shown to
provide sensory recovery but are inferior to autologous nerve grafting
for motor regeneration

Answer 22

T

Question 23

equivalent sensory outcomes for processed nerve allografts when compared
with nerve autografts, and they had superior sensory outcomes when
compared with nerve conduits

Answer 23

T

Question 24

For a successful reconstruction, soft-tissue coverage should be
taken from outside the zone of injury for adequate healing

Answer 24

T

Question 25

Fasciocutaneous flaps are usually the work horse flaps for mutilating upper extremity injuries

Answer 25

T

Question 26

1% of all upper extremity trauma patients will need a fasciotomy, especially in those patients who suffered an arterial and venous injury

Answer 26

T

Question 27

All compartments within the hand and forearm must be fully
released for adequate decompression

Answer 27

T

Question 28

in instances
with vascular compromise in the mangled upper extremity, preemptive compartment releases should be performed because of the reperfusion injury and muscle ischemia after the return ofblood flow.

Answer 28

T

Question 29

children tend to have better outcomes when compared
with adults.

Answer 29

T

Question 30

in children, epiphyseal plates may still be intact, and bones
may continue to grow after the injury or replantation,

Answer 30

T

Question 31

Despite being immobilized for longer periods of time, children recover mobility of the operated extremity much easier than adults.

Answer 31

T

Question 32

loss of wrist and finger motion, neurogenic
pain, andheterotopic ossification contribute to delayed upper extremity amputation

Answer 32

T

Question 33

Even with the most meticulous technique, mutilating upper extremity injuries often result in
poor motor and sensory recovery

Answer 33

T