Galassi L, Facchinetti F. Towards comprehensive care in crush syndrome: Expanding the multidisciplinary framework. World J Orthop 2025; 16(9): 111218 [DOI: 10.5312/wjo.v16.i9.111218]
Corresponding Author of This Article
Luca Galassi, Lecturer, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Via festa del perdono 7, Milan 20122, Lombardy, Italy. lucagalassimd@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2025; 16(9): 111218 Published online Sep 18, 2025. doi: 10.5312/wjo.v16.i9.111218
Towards comprehensive care in crush syndrome: Expanding the multidisciplinary framework
Luca Galassi, Federica Facchinetti
Luca Galassi, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Milan 20122, Lombardy, Italy
Federica Facchinetti, School of Medicine and Surgery, University of Milan-Bicocca, Monza 20900, Lombardy, Italy
Author contributions: Galassi L wrote the original draft; Facchinetti F contributed to conceptualization, writing, reviewing, and editing; Galassi L and Facchinetti F participated in drafting the manuscript; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: Luca Galassi and Federica Facchinetti declare that they have no conflicts of interest relevant to this letter.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Galassi, Lecturer, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Via festa del perdono 7, Milan 20122, Lombardy, Italy. lucagalassimd@gmail.com
Received: June 26, 2025 Revised: July 10, 2025 Accepted: August 1, 2025 Published online: September 18, 2025 Processing time: 77 Days and 2.7 Hours
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.
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.
