DECISION-MAKING AND RESULTS IN SUBTOTAL AND TOTAL LOWER LEG AMPUTATIONS - RECONSTRUCTION VERSUS AMPUTATION

As a result of modern therapeutic and technological advances, the surg eon has the ability to salvage even the most severely injured lower li mbs. However, the success of replantation nowadays is no longer measur ed simply on the basis of restoration of viability but also on functio nal outcome compared with primary amputation with early prosthetic fit ting, the risk to the patient during and after replantation and the ov erall time of treatment which should not exceed 2 years. Although ever y major limb replantation has to be considered individually, the decis ion-making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation-like injuries to the lower leg has been developed and te sted in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of ''funct ional extremities'' but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a ''non-functional ex tremity'', and no patient required a secondary re-amputation. The repl antation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no pat ient died during or after replantation. Based on our experience, if re construction in subtotal or total lower leg amputation is done for a w ell-selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re-integration can be achieved. (C) 1996 Wiiey-Liss, Inc.