Initial care of massively traumatized lower extremities.

From July 1985 through July 1987, 19 patients with 20 massively traumatized lower limbs were treated using a standardized protocol, including early consultation with microvascular and plastic surgeons and a nurse-practitioner. This early consultation allowed for timely reconstruction as well as patient and family counseling. Thirteen of these 20 limbs (65%) were salvaged. Of the seven amputations, one patient died and two patients were lost to follow-up study. The results of the 16 remaining patients with 17 affected limbs were reviewed. Seventy-five percent were ambulatory in less than one year following surgery. All were ambulatory without external aids or orthoses at final follow-up examination. A rapid return to previous activities was a direct result of early decision making.