PRIMARY SHORTENING WITH SECONDARY LIMB LENGTHENING IN SEVERE INJURIESOF THE LOWER LEG - A 6 YEAR EXPERIENCE

Multiple secondary grafting procedures may be necessary in cases of co mplete or partial amputation of the lower limb if the aim is to preser ve the initial limb length. The traditional concept of staged reconstr uction often leads to a prolonged hospitalisation and a high complicat ion rate, especially in cases with segmental nerve defects of more tha n one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a prima ry shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months a fter replantation, secondary limb lengthening is started, using an ext ernal or internal distraction device. Since 1985, 7 patients presentin g with complete or partial amputation of the lower leg had been treate d using this concept. The indications, operative technique, complicati ons and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting. (C) 1993 Wiley-Liss, Inc.