The management of combined skeletal and arterial injuries of the lower extremity.

Combined skeletal, soft-tissue, and arterial injuries in lower extremity trauma are relatively common. Controversy has surrounded the priority of management of these limb- and life-threatening injuries. There are proponents for initial skeletal stabilization, and an equal number in favor of initial revascularization. The management of a multiply-traumatized patient with an ischemic limb and other life-threatening injuries, and a literature review, are presented to examine some of the issues and describe the use of vascular shunts as a method for rapid temporary revascularization of a damaged limb.