Salvage of traumatized of extremities or their appendages restores morale in working class of society

Introduction
Salvage in trauma is quite infrequent. Quality of life among subjects with crush injuries of extremities as an outcome of traumata of varied aetiology is often improved by salvage procedures. To prevent or minimize psycho-social derangement (MDD) or its implications by minimising partial or total loss of traumatized body parts and restore useful function.

Methods
20 year study/observation in trauma of limbs, hands, feet, fingers, toes with partial to near total vascular compromise sustained in road traffic, industrial, domestic, suicidal, homicidal, war wounds, fire work blasts, etc. accidents. Integrated multidisciplinary method of evaluation emphasised. Pre-operative/follow-up counselling of every patient, attendants and employer are of utmost importance. Primary debridement, stabilization, skin cover and serial paraffin-gauge dressings are followed with straps/splints, passive/active range of movement exercises and delayed suture removal. Antibiotic cover with sequential cultures are mandatory.

Results
Compromised vascular crushes with primary closure, salvage was possible. Cosmesis in working class is never the priority, but restoration of function and the chance of livelihood are. Dexterity and confidence come with practice. Richer the patient, tougher to convince. Psycho-social depression is more with early amputations than in revisions and much less in salvaged groups, commoner in men and unmarried illiterate women. Women adapt better to salvaged parts.

Discussion
Sepsis is a challenge. Males, youth, hands, Grade II wounds and RTAs dominate incidence. Contamination, delayed presentation, poor compliance and follow-up, poor nutritional status, anaemia, etc., dread salvage. Initial poor tissue perfusion is no indication for early decision to amputate/terminalize.Even a nail lost with its bed is lost forever, leaving a painful defunct stump. No riches can truly compensate. If soft tissue cover on bony elements and neuro-vascular bundles is achievable, an entire limb may survive and regain near normal function. When crush wounds remain aseptic a decision to amputate can wait.