Management of the Mangled Upper Extremity

* Management of the mangled upper extremity prioritizes life before limb, with control of bleeding most often achieved with direct pressure. * Infection is reduced by immediate antibiotic administration, excisional debridement within 24 hours, skeletal stabilization, and wound management that promotes healing. * High-pressure irrigation, soaps, and prolonged antibiotics have unclear benefit, and possible harm, with respect to the ultimate outcome of the mangled upper extremity. * Complex bone, nervous, vascular, and soft-tissue injuries require individually tailored reconstruction, frequently performed at a specialized center. * Occupational therapy, physical therapy, prosthetics, and psychological support are essential parts of the management and should be considered at each stage throughout recovery.