Cavadas Pedro C, Landín Luis, Ibáñez Javier, Roger Ignacio, Nthumba Peter
Valencia, Spain From Reconstructive Surgery, Clínica Cavadas.
Plast Reconstr Surg. 2009 Aug;124(2):532-539. doi: 10.1097/PRS.0b013e3181addc1e.
Replantation surgery in lower extremity amputations continues to be controversial. Overall results have been considered poor and the procedure is usually discouraged. It is the opinion of the authors that infrapopliteal replantation may be indicated.
A series of 12 patients with 13 amputations through the tibia or below were treated with replantation of the parts. The main indication was an intact sole and amenability of direct tibial nerve repair. Extensive bone loss or soft-tissue damage was not a contraindication. All replantations were orthotopic, and in one case a temporary ectopic replantation was performed. All transtibial replantations underwent subsequent bone lengthening (8 to 13 cm).
The survival rate of the replanted segments was 100 percent. There was one death caused by pulmonary thromboembolism. The number of additional operations was 3.1 (range, one to five). Soft-tissue necrosis occurred in 83 percent of cases, requiring flap coverage. A free flap was used in 90 percent of these cases, with a 100 percent success rate. Chen functional grade was I or II (good or excellent) in all but one case. Treatment time averaged 11.3 months (range, 8 to 16 months). No delayed amputations or plantar ulcers occurred.
Although the complication rate has been high, in dedicated teams and with proper selection of patients, replantation of infrapopliteal lower limb amputations can yield satisfactory results.
下肢截肢再植手术一直存在争议。总体结果被认为较差，该手术通常不被提倡。作者认为，腘以下截肢再植可能是可行的。
对12例共13处经胫骨或其以下部位截肢的患者进行了断肢再植治疗。主要指征是足底完整且胫神经可直接修复。广泛的骨质缺损或软组织损伤并非禁忌证。所有再植均为原位再植，1例进行了临时异位再植。所有经胫骨再植术后均进行了骨延长（8至13厘米）。
再植肢体的成活率为100%。有1例因肺血栓栓塞死亡。额外手术次数为3.1次（范围为1至5次）。83%的病例发生软组织坏死，需要皮瓣覆盖。其中90%的病例采用游离皮瓣，成功率为100%。除1例病例外，所有病例的陈式功能分级均为Ⅰ级或Ⅱ级（良好或优秀）。治疗时间平均为11.3个月（范围为8至16个月）。未发生延迟截肢或足底溃疡。
尽管并发症发生率较高，但在专业团队和适当选择患者的情况下，腘以下下肢截肢再植可取得满意结果。
