Lower extremity replantation

Replantation of the traumatically amputated lower extremity is a technically feasible surgical undertaking. Successful outcome must be judged by functional achievements of the patient toward returning to the preinjury level. Appropriate patient selection significantly increases the potential for obtaining a satisfactory outcome. Patients in whom peripheral nerve injury precludes return of sensation in the extremity or in whom severe joint destruction will yield an immobile extremity will have marginal results. The risks of replantation, including blood transfusions, sepsis, and prolonged hospitalization, must be weighted heavily against prosthetic substitution as an alternative. If the lower extremity can be successfully replanted, however, this provides a superior functional and aesthetic result for the patient. Salvage replantation to preserve maximal functional length and durability of an extremity must always be considered when assessing a patient with a traumatic amputation. Free-tissue transfer to salvage a threatened replanted limb must be similarly a part of the armamentarium of the replantation surgeon. Although lower limb replantation may continue to be controversial, improved surgical techniques and increasing experience make it an excellent alternative to prosthetic substitution. In the well-motivated patient, an excellent result may be achieved.