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Musculoskeletal Injuries and Microvascular Surgery

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Anesthesia for Trauma

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Abstract

Trauma patients often present with a multitude of musculoskeletal injuries ranging from minor strains and sprains to complex open fractures and mangled extremities. Although musculoskeletal injuries rarely pose a direct threat to life, appropriate early management is critical in order to minimize significant long-term disability. Advanced Trauma Life Support guidelines state the first priority of musculoskeletal injury management is recognizing and controlling hemorrhage and immobilizing fractures. During the secondary survey, limb threatening injuries are identified, with a focus on open fractures and areas of compromised vascular and nerve supply. The hallmarks of surgical management begin with wound irrigation, debridement of devitalized tissue, alignment of fractures, adequate hemostasis, and appropriate antibiotic usage. Early return of blood flow and prompt wound closure is associated with improved fracture healing and reduced infection. Since the 1960s, the ability to close wounds and reconstruct traumatic injuries has been revolutionized with the expansion of microsurgical techniques within the fields of vascular, orthopedic, and plastic surgery. Free flap reconstruction after significant musculoskeletal trauma is now a common and standard practice for closing tissue defects, providing structural repair and optimizing functionality. Knowledge of the microsurgical interventions available for traumatic musculoskeletal injuries and understanding optimal perioperative management is critical to the successful care of these injured patients.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, UCLA David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, USA

    David W. Boldt M.D., M.S.

  2. Department of Anesthesiology, UCLA David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, USA

    Zarah D. Antongiorgi M.D.

Authors
  1. David W. Boldt M.D., M.S.
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  2. Zarah D. Antongiorgi M.D.
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Corresponding author

Correspondence to David W. Boldt M.D., M.S. .

Editor information

Editors and Affiliations

  1. Bellevue Hospital Center, New York University, New York, New York, USA

    Corey S. Scher

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Boldt, D.W., Antongiorgi, Z.D. (2014). Musculoskeletal Injuries and Microvascular Surgery. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_12

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  • DOI: https://doi.org/10.1007/978-1-4939-0909-4_12

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