{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:57:48Z","timestamp":1787101068590,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T00:00:00Z","timestamp":1596758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.<\/jats:p>","DOI":"10.3390\/medicina56080398","type":"journal-article","created":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T05:07:23Z","timestamp":1597036043000},"page":"398","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Multistep Iter for Functional Reconstruction in Mangled Upper Limb: A Retrospective Analysis of Integrated Surgical and Medical Approach"],"prefix":"10.3390","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-7828","authenticated-orcid":false,"given":"Francesco","family":"De Francesco","sequence":"first","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marchesini","sequence":"additional","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Campodonico","sequence":"additional","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Dietrich","family":"Neuendorf","sequence":"additional","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Paolo","family":"Pangrazi","sequence":"additional","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Riccio","sequence":"additional","affiliation":[{"name":"Department of General and Specialties Surgery, SOD of Reconstructive Surgery and Hand Surgery, AOU \u201cOspedaliRiuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,7]]},"reference":[{"key":"ref_1","first-page":"226","article-title":"The mangled extremity syndrome (MES): A severity grading system for multisystem injury of the extremity","volume":"3","author":"Gregory","year":"1985","journal-title":"J. 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