Towards comprehensive care in crush syndrome: Expanding the multidisciplinary framework

Abstract

Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery. In response to Khan et al’s recent systematic review, we propose complementary perspectives that address two underrepresented dimensions: Vascular surgical decision-making and psychiatric rehabilitation. We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management. Additionally, we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors. Embedding these domains into standardized protocols could enhance both short- and long-term outcomes, particularly in high-impact trauma and disaster settings.

Keywords: Crush syndrome; Compartment syndrome; Reperfusion injury; Thromboembolism; Fasciotomy; Mental health; Multidisciplinary management

Core Tip: This letter expands on Khan et al’s review by emphasizing two often overlooked aspects of crush syndrome: Intraoperative vascular decision-making and psychiatric rehabilitation. We highlight the use of perfusion assessment tools and tailored anticoagulation strategies to improve limb salvage. Additionally, we advocate for early screening of post-traumatic stress disorder (PTSD), depression, and anxiety using validated tools like PTSD Checklist for DSM 5 and Patient Health Questionnaire 9. These additions aim to integrate surgical precision with trauma-informed mental health care, supporting a more holistic and outcome-focused approach to managing crush injuries, especially in disaster and high-impact trauma settings.