ABSTRACT
Some replantation cases require substantial bone shortening for primary closure. Leg-length
discrepancy can be restored by lengthening of the replanted or revascularized extremities.
Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations
had replantation or revascularization for their severely damaged extremities. All
of them had extensive debridement, vascular repair, bone shortening and nerve repair
for sensibility of their soles. One of the replanted extremities failed and had to
undergo below-knee amputation because of sepsis. No other infection or vascular complications
were encountered following the replantations or revascularizations. After bony consolidation,
four legs were lengthened; for elimination of length discrepancy in three cases, and
for obtaining balanced body proportion in one case in which the other leg was also
amputated. In all procedures, a unilateral dynamic axial external fixator was used.
The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal
osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score
(MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity,
because of the required debridement of soft tissue and bone. These authors think the
amount of limb shortening is not a major criterion in evaluating a traumatic total
or subtotal below-knee amputation for salvage replantation or revascularization. A
knee that has stable joint motion and the possibility of preservation of sensibility
of the sole broadens the scope of indications for limb salvage, even with deliberate
shortening that can be restored by lengthening; length discrepancy is not a contraindication
for limb salvage.
KEYWORDS
Lower limb replantation - revascularization - lengthening
