Introduction

Severe limb trauma often results in substantial injuries to multiple tissue types, including bone, skeletal muscle, nerve, and vasculature. These injuries generally present increased clinical challenges and frequently cannot be managed with conventional reconstruction techniques. Furthermore, due to the complex nature of these injuries, there is no real consensus on intervention strategies [1–3]. Given the inherent severe and pervasive tissue damage, multistage treatment is routinely required, and patients are typically encumbered with diminished long-term function even if limb salvage and reconstruction are successful [4, 5].

Extremity trauma remains the predominant type of combat casualty for US armed forces members engaged in ongoing military conflicts, a continuation of historical trends. Explosive munitions are the primary cause of these injuries [6, 7], resulting in penetrating blast wounds with large zones of injury that encompass multiple tissue types, and, notably, a high incidence of bone and soft-tissue trauma [6] (Figure 29.1). High-energy trauma incidents, such as motor vehicle collisions, produce an additional civilian patient population. Although passenger survival in these incidents has increased with improved engineering of safety features, severe extremity trauma remains common [8, 9].