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[Principles of management of high-energy injuries of the leg].

INTRODUCTION
High-energy traumas are open or closed injuries caused by force (missile, traffic injuries, crush or blust injuries, falling from heights), affecting the body surface and transferring high amount of kinetic energy inducing great damage to the tissue. Management of such lower extremity injuries has evolved over past several decades, but still remains a difficult task for every surgical team. Specific anatomic and functional characteristics combined with extensive injuries demands specific treatment protocols.


MULTIPLE INJURIES
In a multiple injured patient the first priority is management of life-threatening trauma. Despite other injuries, surgical treatment of limb-threatening injuries must start as soon as life-threatening condition has been managed.


TREATMENT ALGORITHMS
Algorithms are especially beneficial in management of severely injured, but salvageable extremities and in making decision on amputation. Insight into mechanisms of injury, as well as systematic examination of the affected limb, should help us understand the extensiveness of trauma and make an adequate management plan.


PREVENTION OF INFECTION AND SURGICAL APPROACH
Prevention of wound infection and surgical approach to high-energy limb trauma, which includes wound extension, wound excision, skeletal stabilization and if necessary muscle compartment release, should be done in the first 6 hours after injury.


METHODS OF SOFT TISSUE RECONSTRUCTION
Commonly used methods for soft tissue defects must provide wound coverage in less than five days following injury.


REHABILITATION
Early passive and active mobilization and verticalization of patients is very important for successful treatment.


CONCLUSION
Good and timely evaluation of the injured and collaboration between plastic and orthopaedic surgeons from the beginning of treatment, are crucial for final outcome.