Lower Extremity Trauma

219 Pages·2006·3.795 MB·\219

by  Milton B. Armstrong (Editor)

Lower extremity
Trauma
Edited by
Milton B. Armstrong
University of Miami
Miami, Florida, U.S.A.
DK3501_C000a.indd 3 10/09/2006 2:38:59 PM
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To my sons Christopher and Bryan;
to my parents, James and Cornelia Armstrong, for their guidance, love,
and support;
to Annette, Jauqua, and Khara for all of their love;
to my immediate family, for their encouragement of all my efforts.

Preface
Increasingly, urban trauma is becoming a major health care issue. Large emer-
gency departments are inundated with patients with multiple injuries, requiring
state-of-the-art care. Most of these complex injuries involve trauma to the extrem-
ities, often due to motor vehicle accidents. In a study by MacKenzie et al. (1), it
was shown that lower extremity injuries accounted for about 40% of the charges
for motor vehicle trauma treatment in a given year.
This book is designed to be a guide for the evaluation and management by
physicians, nurses, students, and support personnel involved in the care of severely
injured patients. I am very pleased to have an outstanding group of contributors from
the University of Miami/Jackson Memorial Hospital Medical Center. University of
Miami/Jackson Memorial Hospital serves as the primary Level 1 trauma referral
center for South Florida. With such a tremendous volume of trauma patients, Univer-
sity of Miami/Jackson Memorial Hospital and its staff manages some of the most
complicated lower extremity trauma problems on a daily basis.
University of Miami/Jackson Memorial Hospital employs a comprehensive
system that allows for the coordination of care amongst multiple surgical ser-
vices. These services include trauma/critical care, orthopedic trauma, vascular,
and plastic surgery—all areas thoroughly covered within this text.
Milton B. Armstrong
REFERENCE
1. MacKenzie EJ, Cushing BM, Jurkovich GJ, et al. Physical impairment and functional
outcomes six months after severe lower extremity fractures. J Trauma 1993; 34(4):
528–539.
v

Acknowledgments
I am deeply indebted to my current and former University of Miami residents and
fellows, my colleagues in the University of Miami Division of Plastic Surgery,
the University of Miami Department of Surgery, and contributing authors from
around the country.
vii

Contents
Preface . . . . v
Acknowledgments . . . . vii
Contributors . . . . xi
1. Basic Principles of Trauma Care . . . . . . . . . . . . . . . . . . . . . . 1
Yoram Klein, Igor Jeroukhimov, Stephen M. Cohn,
and Mark Cockburn
2. Lower Extremity Surgical Anatomy . . . . . . . . . . . . . . . . . . . . 17
Kerry Latham, Marcelo Lacayo Baez, Milton B. Armstrong,
and Efrain Arias
3. Orthopedic Treatment of the Traumatized
Lower Extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Steven P. Kalandiak
4. Vascular Trauma of theLower Extremity . . . . . . . . . . . . . . . 93
Fahim A. Habib, Pranay Ramdev, and Darwin Eton
5. Skin, Fasciocutaneous, and Muscle Flap Anatomy . . . . . . . . 113
Flaps: Classification, Form, and Function
Sabrina Lahiri and Rajeev Venugopal
6. Soft-Tissue Repair for Proximal
and Middle Third Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Joshua Kreithen, Kerri Woodberry, and Seung-Jun O
ix