Mechanism of injury/etiology of wound (traumatic, oncologic, vascular insufficiency, other).

Medical comorbidities: Cardiopulmonary or peripheral vascular disease, diabetes, obesity, hematologic disorders, nutritional status, collagen/vascular disorders, steroid use.

Tobacco use.

Preoperative functional status.

Support network.

Primary survey

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  Airway, breathing, circulation.

  
  
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  Assess for vascular compromise.

  
  
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  Distal pulses.

Secondary survey

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  Concomitant injuries.

  
  
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  Extent of lower extremity injury: Neurologic and musculotendinous examinations.

  
  
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  Assess exposed structures: Nerves, vessels, joints, tendons.

Potential donor sites.

Fractures: Gustilo classification system of open tibial fractures (see Table 21.1).

Plain films: Including one joint above and one below site of injury.

Angiography

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  Emergent setting: If concern for vascular compromise.

  
  
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  Subacute setting: If no vascular compromise, to evaluate zone of injury and vascular access for reconstruction.