From Salvageability to Lethality: Bridging Vascular Trauma Surgery and Forensic Medicine Through an Evidence-informed Forensic–Vascular Salvageability Index – A Narrative Review

Abstract Severe traumatic hemorrhage is a dominant pathway to early death after injury, with a substantial proportion of early mortality attributable to exsanguination and major vascular disruption in both civilian and military datasets. Contemporary vascular-trauma care has improved survival through rapid hemorrhage control, damage-control resuscitation, and structured algorithms for extremity and truncal vascular injury management. In parallel, forensic medicine must reconstruct the cause, mechanism, and manner of death using scene context, medical records, and postmortem findings, including increasingly postmortem cross-sectional and angiographic imaging. However, the conceptual and practical “translation layer” between clinical salvageability (what could have been survivable with timely vascular control and resuscitation) and forensic lethality reconstruction (how the injury produced fatal physiology and what can be proven from postmortem evidence) is not standardized. This narrative review synthesizes vascular-trauma decision principles and forensic death-investigation standards to propose an evidence-informed framework – the Forensic–Vascular Salvageability Index (FVSI) – that jointly characterizes vascular injury along three axes: (1) Clinical Salvageability (feasibility and time-dependence of hemorrhage control and revascularization), (2) Forensic Lethality Reconstruction (strength of evidence that hemorrhage and vascular disruption were the proximate fatal pathway), and (3) Context/Timeline Modifiers (delays, compressibility, and system capability). FVSI is presented as a prototype scoring rubric and reporting template supported by tables and implementation scenarios intended to enable research harmonization, improve medicolegal communication, and support preventable-death review without substituting for clinical judgment or legal determinations.