Lower leg replantation--decision-making, treatment, and long-term results

The aim of this article is to review the results of replantation at the lower leg after total and subtotal amputation injury. Although subtotal and total lower leg amputations have been successfully replanted in the past, nowadays there is a common opinion that these operations do not justify their efforts, and therefore most of those patients are amputated.

To clarify this hypothesis we carried out an extensive literature research. The following criteria were evaluated: 1) survival rate, 2) individual motor and sensory functions and global lower extremity function judged according to the classification of Chen, 3) socioeconomic aspects (operation time, number of operations per patient, time of hospitalization, and return to normal life), and 4) number and nature of local and/or systemic complications.

The success rate of lower leg amputation, which only means perfect restoration of viability, is reported between 62.5% and 100%. Using Chen's classification the functional results can be given as follows: A "functional extremity" (grade I and grade II) can be reconstructed in 82.6% to 92.7%. A non-functional extremity (grade III and grade IV) will result in one tenth to one fifth of cases. Complications can be classified in local or systemic and occur depending on the quality of the decision-making process.

Our results as well as those of other large series show that lower leg replantation is still worthwhile in a well selected patient group, contrary to what is believed by an increasing number of orthopaedic and trauma surgeons.