Progressive trends in timing and imaging of lower extremity reconstruction

The salvage of mangled lower-extremities after severe injury remains a daunting operative dilemma, but one that continues to evolve with advances in microsurgical and orthopedic techniques. Specifically, trends in clinical practice including the decision to salvage and timing of soft-tissue coverage are changing in concordance with improvements in wound care, flap selection for soft-tissue provision, and preoperative imaging. Due to these improvements, more complex wounds are increasingly eligible for reconstruction. It remains unclear, however, whether success in limb salvage confers improved functional patient outcomes. We present a review of the literature tracing recent advances in the salvage of mangled extremities following traumatic injury, with a focus on practice trends regarding timing of reconstruction, operative approaches, and preoperative imaging.