plastische, reconstructieve en esthetische chirurgie - UZ Leuven

„functional extremity“ can be reconstructed at the upperarm level in 22 to 34%, proximal forearm level 30 to 41%and distal forearm level 56 to 80%. All patients neededat least 2 secondary operative procedures. 5 of 65patients were reamputated because of postoperativecomplications. As the functional results after replantationare at least equal (proximal level) or even far superior(distal level), some protective sensibility at the hand canbe expected even at the most proximal levels, and themissing psychological impairment caused by missingbody integrity, reconstruction should be carried out ifpossible, reasonable with regard to the expectedfunction, estimated of low risk for the patient anddesired. The higher cost and amount of operationsneeded, as well as the longer postoperative care andlonger time of disability after replantation are justified bya significant increase in life quality.HIERNER R., BETZ A., POHLEMANN T., BERGER A.: Longtermresults after lower leg replantation – does the resultjustify the risks and efforts? Eur. J. Trauma, 2005; 4: 389-398.Although subtotal and total lower leg amputation havebeen successfully replanted in the past, nowadays thereis a common opinion that "these replantations do notjustify their efforts, and therefore the patients shouldundergo primary amputation". In order to clarify thishypothesis we carried out a retrospective clinical study ofour personal cases operated on between 1981 – 1998and an extensive literature research. The followingcriteria were evaluated 1) survival rate, 2) individualmotor and sensory functions and global lower extremityfunction judged according to the classification of CHEN,3) socioeconomic aspects (operation time, number ofoperations per patient, time of hospitalization, return tonormal life), 4) number and nature of local and/orsystemic complications and 5) subjective judgment bythe patient.All replanted lower legs in our series survived. UsingCHEN`s classification the functional results can be givenas 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 wasachieved within 8 to 10 months after replantation. 4 to 7secondary operations were carried out in every patient inorder to improve the result. Total duration of therapy took28 to 48 months. There were no secondary reamputation.Using our personal algorithm, on the one hand there is asignificant decrease in replantation frequency (30% of alltransferred cases in our replantation centre). However,on the other hand those cases replanted show betterfunctional and aesthetic results and a significant lowerreplantation risk. Our results as well as those of otherlarge series show that lower leg replantation is stillworthwhile in a well selected patient group, contrary towhat is believed by an increasing number of orthopaedic