A study of pattern, management, and outcome of complex soft-tissue injuries

Document Type : Original Article


1 Department of General Surgery, Be Well Hospitals, Chennai, Tamil Nadu, India

2 Department of Community Medicine, ACS Medical College, Chennai, Tamil Nadu, India



Background and Objectives: Complex soft-tissue injuries are one of the leading causes of morbidity and mortality following road traffic accidents (RTA). This article is regarding the pattern, management, and outcome of complex soft-tissue injuries. 
Methods: This observational study was conducted on 519 patients, from January 01, 2010, to April 30, 2013, at a tertiary care center in southern India. We analyzed the demographic profile, mechanism of injuries, management, and outcome of complex soft-tissue injuries during this study. 
Results: Of 519 patients with soft-tissue injury, blunt and penetrating injuries were seen in 81.7% and 18.3% of all cases, respectively. The most common cause of injury was RTA 74.3%. Isolated moral Lavelle injuries without associated neurovascular injuries occurred in 26.3% of patients. Soft-tissue injury was associated with bony, vascular, nerve, and tendon injuries in 52.0%, 44.7%, 20.0%, and 16.3% of all the cases, respectively. Patients who presented early (within 6 h of injuries) and patients with bone-only injuries had higher limb salvage rates. The overall morbidity rate among adults was 16.3% and the mortality rate was 1.9% and the most common cause of death was hemorrhagic shock. Mortality and morbidity in the pediatric group are higher than in the adult group. 
Conclusions: In summary, health education about road safety and proper safety protocol for two-wheelers and four-wheelers will reduce the incidence of RTA, thereby reducing the incidence of complex soft-tissue injury. The early and aggressive intervention will prevent a high amputation rate in bony injuries combined with vascular injury. A low threshold of blood transfusion and early aggressive treatment in the pediatric population will reduce the high mortality rate.


Jayabal Pandiaraja [Pubmed] [Google Scholar]



Sakran JV, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: Trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med 2012;20:64.  Back to cited text no. 1
Sanyang E, Peek-Asa C, Bass P, Young TL, Daffeh B, Fuortes LJ. Risk factors for road traffic injuries among different road users in the Gambia. J Environ Public Health 2017;2017:8612953.  Back to cited text no. 2
Dua A, Desai SS, Shah JO, Lasky RE, Charlton-Ouw KM, Azizzadeh A, et al. Outcome predictors of limb salvage in traumatic popliteal artery injury. Ann Vasc Surg 2014;28:108-14.  Back to cited text no. 3
Keeley J, Koopmann M, Yan H, DeVirgilio C, Putnam B, Plurad D, et al. Factors associated with amputation after popliteal vascular injuries. Ann Vasc Surg 2016;33:83-7.  Back to cited text no. 4
Huh J, Stinner DJ, Burns TC, Hsu JR, Late Amputation Study Team. Infectious complications and soft tissue injury contribute to late amputation after severe lower extremity trauma. J Trauma 2011;71:S47-51.  Back to cited text no. 5
Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: Results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 2001;33:1212-9.  Back to cited text no. 6
Yavuz C, Demirtas S, Caliskan A, Ertas F, Kaya H, Aydin M, et al. The predictors of poor outcomes in patients with femoral artery injuries. Eur Rev Med Pharmacol Sci 2013;17:1901-8.  Back to cited text no. 7
Gopinathan NR, Santhanam SS, Saibaba B, Dhillon MS. Epidemiology of lower limb musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India. Indian J Orthop 2017;51:199-204.  Back to cited text no. 8
[PUBMED]  [Full text]  
Wong TH, Krishnaswamy G, Nadkarni NV, Nguyen HV, Lim GH, Bautista DC, et al. Combining the new injury severity score with an anatomical polytrauma injury variable predicts mortality better than the new injury severity score and the injury severity score: A retrospective cohort study. Scand J Trauma Resusc Emerg Med 2016;24:25.  Back to cited text no. 9
Hacquebord JH, Hanel DP, Friedrich JB. The Pedicled Latissimus Dorsi flap provides effective coverage for large and complex soft tissue injuries around the elbow. Hand (N Y) 2018;13:586-92.  Back to cited text no. 10
Hokkam E, Gonna A, Zakaria O, El-Shemally A. Trauma patterns in patients attending the emergency department of Jazan general hospital, Saudi Arabia. World J Emerg Med 2015;6:48-53.  Back to cited text no. 11
Sharma M, Lahoti BK, Khandelwal G, Mathur RK, Sharma SS, Laddha A. Epidemiological trends of pediatric trauma: A single-center study of 791 patients. J Indian Assoc Pediatr Surg 2011;16:88-92.  Back to cited text no. 12
[PUBMED]  [Full text]  
Chagomerana MB, Tomlinson J, Young S, Hosseinipour MC, Banza L, Lee CN. High morbidity and mortality after lower extremity injuries in Malawi: A prospective cohort study of 905 patients. Int J Surg 2017;39:23-9.  Back to cited text no. 13