Innovative Techniques for Maximizing Limb Salvage and Function.
Concurrent injuries to multiple extremities present unique challenges to the reconstructive surgeon. The primary goal in such scenarios is to optimize functional outcomes. The goal of this article is to present an overview of various techniques necessary to provide sufficient soft tissue and preserve amputation limb lengths and function. The concept of innovative techniques for maximizing limb savage and function is presented using an index patient with multiple extremity third- and fourth-degree burn injuries resulting in nonsalvageable lower extremities and severe left-hand wounds. A review of other potential innovative techniques is discussed. The burn injury resulted in a need for bilateral guillotine below-knee amputations. Above-knee amputation was avoided in the left leg using a parascapular free fasciocutaneous flap, while through-knee amputation was preferred to above-knee amputation in the right leg. The preservation of areas with questionable viability resulted in salvaging the left hand of the patient using digital palmar flaps to resurface the dorsum with creation of a first web-space. Maintenance of maximal viable length of limbs and any residual function in the limbs can be of significant functional benefit to multiple limb amputation patients. Maximizing the limb length in such patients is critical, and typical "rules" that have traditionally been utilized to minimize numbers of operations and optimize prosthetic fit may not apply.
From the *Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ‡Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China; §Division of Trauma, Burns, and Critical Care; and ‖Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Mansher
M
Singh
Hehuan
H
Li
Kristo
K
Nuutila
K C
KC
Collins
Jennifer
J
Wall
Robert
R
Riviello
Michael J
MJ
Weaver
Matthew J
MJ
Carty
Julian
J
Pribaz
Simon G
SG
Talbot
D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000328:Adult; D000671:Amputation, Surgical; D002056:Burns / Q000209:etiology / Q000601:surgery*; D005121:Extremities / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D020127:Recovery of Function; D013524:Surgical Flaps; D016896:Treatment Outcome