Clinical Study Of Replantation Of Complex Amutated Limb

[Objective] to explore the indication of complex amputated limb replantation surgery, replantation of amputated limbs processing and preservation, the design of replantation surgery and rehabilitation care, in order to improve the limb replantation survival rate and good and excellent rates of limb function.[Method] 55 patients with complex amputated limb were retrospectively analyzed from October 2003 to October 2011 in our hospital, including 24 cases with complete amputated limb 31 incomplete amputated limb. All amputated limbs were protected by low-temperature liquid (heparin + dexamethasonc + energy + lidocaine mixture + ringer) and intermittent flushing.50 of 55 patients had different degree of tissue defects such as skin, bone, blood vessels.13 cases'limbs were shortened to solve tissue defect problem after the debridement; 37 cases of large tissue defect were treated by free tissue transplantation, of which 7 cases combined with bones, skin and vascular defects were treated with fibula flap or cutaneous iliac flap combined tissue transplant. Severe contamination cases were used the VSD equipment. Rehabilitation programmes were carried out in the 1th week,8 days-3 weeks,4-8 weeks and 9-16 weeks after surgery, respectively.[Results] following-up with 7 months-3 years, except the 2 cases of amputation, limbs in the remaining cases were survival. The survival rate is 96.3%.37 cases of lower limb amputation injuries, according to Shanghai sixth people's Hospital Chen Zhongwei standards for evaluating lower extremity replantation function,19 cases in level one,15 cases in level two,2 cases in level three,1 cases was failure.18 cases of upper extremity injury, according to Chinese Medical Association society of hand surgery of upper extremity replantation of functional evaluation standards,7 cases in level one,7 cases in level two,2 cases in level three,I case in level four,1 cases was failure. Total fine rate is 87.3%.2 cases in 53 cases was partly venous skin flaps necrosis, reselect the other skin flap to heal wound; 9 cases with osteomyelitis were healed by late positive; 19 cases with wound partial opening did not issue closed, but after skin graft or flap the wound were healing again, all remaining cases wound healing.[Conclusion] Limb amputation injuries were complex, according to the specific conditions of individual, scheme operation increases survival rate of surgery of limb replantation and good and excellent rates of limb function.