The Mangled Leg

A review of decision-making in the treatment of severe lower leg injuries is presented. In this article, several factors will be discussed which play a decisive role in the choice between an attempt at salvage and primary amputation. Based on these variables, predictive scoring systems have been proposed to objectify the regional injury severity of the limb in order to assist the surgeon in decision-making. The most widely described of these systems are compared. Furthermore, the short- and long-term consequences of treatment are discussed. Finally, a strategy for the treatment of mangled legs is proposed.