Long-Term Results after Lower-Leg Replantation

Abstract

European Journal of Trauma Ab stractBackground: Although subtotal and total lower-leg amputation have been sucessfully replanted in the past, nowadays there is a common opinion that "these replantations do not justify their efforts, and therefore the patients should undergo primary amputation". Patients and Methods: In order to clarify this hypothesis, a retrospective clinical study of own cases operated on between 1981 -1998 and an extensive literature research we carried out. The following criteria were evaluated: (1) survival rate, (2) individual motor and sensory functions and global lower extremity function judged according to the classification of Chen et al., (3) socioeconomic aspects (operation time, number of operations per patient, time of hospitalization, return to normal life), (4) number and nature of local and/or systemic complications, and (5) subjective judgment by the patient. Results: All replanted lower legs in this series survied.Using the classification of Chen et al. the functional results can be given as follows: stage I 64.2%, stage II 28.5% (thus, a "functional extremity" could be reconstructed in 92.7%), stage III 7.1%, and stage IV 0%. Social reintegration was achieved within 8-10 months after replantation. Four to seven secondary operations were carried out in every patient in order to improve the result. Total duration of therapy was 28-48 months. There were no secondary reamputation. Conclusion: Using an algorithm developed by the authors, there is a significant decrease in replantation frequency on the one hand (30% of all tranferred cases in the own replantation center). However, on the other hand those cases replanted show better functional and aesthetic results and a significantly lower replantation risk. The results of this study as well as those of other large series show that lower-leg replantation is still worthwhile in a well-selected patient group, contrary to what is believed by an increasing number of orthopedic and trauma surgerons.

Successful ankle replantation in two cases with different presentations

“…In contrast, in 2002, Battiston et al [5] reported a 100% success rate of lower extremity replantation in nine patients, of whom 78% achieved functional success (Chen grade I or II). In 2005, Hierner et al [6] reported a 62.5% success rate in 15 total and subtotal amputated replantations, of which 92.7% were classified as showing functional success (Chen grade I and II). In a 2009 study by Cavadas et al [1] in Spain, the survival rate was 100% in 12 patients with 13 lower leg amputations who underwent replantation.…”

Vascularised Composite Allotransplantation – Basic Science and Clinical Applications

“…The option to reconstruct an un-salvageable lower limb injury with a VCA is appealing but has traditionally been met with resistance due concerns around poor functional recovery, high-risk surgery and burden of immunosuppression. The on going debate in the field of VCA surrounding the risk: benefit ratio of lower limb VCA originates from the relatively poor functional results historically reported following lower limb replants [53,54]. However, after reports of good functional outcomes of upper limb transplants worldwide, even those at a midhumeral level, the concept of lower limb replant and the possibility of VCA were revisited [18,31,32].…”