Staged major limb replantation: a concept to minimize the risk in replantation of the lower extremity.
The replantation of large limb segments presents two major problems: first, a general danger to survival because of major accompanying injuries and additional ischemia-reperfusion injury; second, local soft-tissue damage at the amputation site. Successful replantation can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible risk reduction may be accomplished by the concept of a two-staged replantation. A brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization (with the goal of limb survival) is followed by a second procedure within 72 hr after trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing, and soft-tissue coverage by free flaps. The advantages of the double procedure are demonstrated in 27 patients by comparison of two treatment groups. Group I comprised 15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation was performed. The second group showed a shorter duration of overall treatment, reduction of blood loss, and fewer infections.
Braun
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Department of Trauma Surgery, University of Saarland Medical School, Homburg/Saar, Germany.
Olinger
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A
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D003646:Debridement / Q000379:methods; D006801:Humans; D007869:Leg Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012307:Risk Factors