AUC Assumptions and Disclaimer

  • Adults (17-64) with high-energy lower extremity trauma (below the knee joint)
  • Consultations with trauma, vascular, and plastic surgeons have been undertaken as necessary
  • Adequate distal perfusion is present or can be restored
  • This AUC only addresses those patients initially admitted to the hospital and prior to definitive wound closure



  • High-energy = Type III fractures, crush or blast injuries, or severe soft tissue degloving injuries
  • Trauma injury = crushed/mangled extremity, burn, muscle loss, bone loss, soft tissue coverage deficit indirect injury, improvised explosive devices (IED), ballistic injury
  • “Advanced/End Stage Comorbidities” include: liver, kidney, heart, lung, peripheral vascular disease (PVD), cancer, neuropathic limb



  • Patients with traumatic amputation
  • Patients in extremis not rapidly correctable due to other systemic injuries and/or polytrauma (i.e. those not able to undergo immediate limb salvage surgery or may need an immediate amputation for survival)


Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.

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