Massive trauma to a limb, even in young children, may lead to loss of
viability and function. A combination of open fracture with vascular,
crush, and avulsion injury resulting in acute peripheral ischemia may
place the extremity at risk of necrosis and imminent amputation. We su
ggest a combined, multidisciplinary approach that includes initial vas
cular repair and fractures fixation, with early institution of hyperba
ric oxygen therapy.