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Lower limb replantations: indications and a new scoring system
Bruno Battiston1, Pierluigi Tos, Italo Pontini
1Gruppo Interdivisionale di Microchirurgia, C.T.O. Hospital, Torino, Italy. bruno.battiston@virgilio.it
Microsurgery
|September 5, 2002
Summary
Lower limb replantation is complex, with outcomes depending heavily on patient selection. A new scoring system, adapted from the Mangled Extremity Severity Score (MESS), aids in predicting success and guiding decisions for these challenging cases.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Microsurgery
Background:
- Lower limb amputations due to high-energy trauma are increasing.
- Replantation indications are controversial due to high complication rates and advances in prosthetics.
- Previous replantation outcomes show variable success, necessitating improved patient selection criteria.
Purpose of the Study:
- To evaluate the outcomes of lower limb replantation.
- To identify factors influencing successful lower limb replantation.
- To develop a predictive scoring system for lower limb replantation candidates.
Main Methods:
- Retrospective review of 14 lower limb replantations in 12 patients (1993-present).
- Assessment of outcomes using Chen criteria.
- Development of a modified Mangled Extremity Severity Score (MESS) incorporating patient age, general condition, injury characteristics, and time.
Main Results:
- All replanted segments survived initially, but 5 required secondary amputation due to complications.
- Of the remaining 9 cases, 7 had good (Chen I-II), 1 sufficient (Chen III), and 1 poor (Chen IV) outcomes.
- Younger patients generally achieved better results.
Conclusions:
- Careful and objective patient selection is crucial for successful lower limb replantation.
- The modified MESS scoring system can aid in decision-making, predict functional outcomes, and guide patient selection.
- Further validation of the scoring system is warranted to optimize replantation strategies.
