Long-Term Results after Lower-Leg Replantation: Does the Result Justify the Risks and Efforts?

Background: 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 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.[PUBLICATION ABSTRACT]