Infrapopliteal lower extremity replantation

Replantation surgery in lower extremity amputations continues to be controversial. Overall results have been considered poor and the procedure is usually discouraged. It is the opinion of the authors that infrapopliteal replantation may be indicated.

A series of 12 patients with 13 amputations through the tibia or below were treated with replantation of the parts. The main indication was an intact sole and amenability of direct tibial nerve repair. Extensive bone loss or soft-tissue damage was not a contraindication. All replantations were orthotopic, and in one case a temporary ectopic replantation was performed. All transtibial replantations underwent subsequent bone lengthening (8 to 13 cm).

The survival rate of the replanted segments was 100 percent. There was one death caused by pulmonary thromboembolism. The number of additional operations was 3.1 (range, one to five). Soft-tissue necrosis occurred in 83 percent of cases, requiring flap coverage. A free flap was used in 90 percent of these cases, with a 100 percent success rate. Chen functional grade was I or II (good or excellent) in all but one case. Treatment time averaged 11.3 months (range, 8 to 16 months). No delayed amputations or plantar ulcers occurred.

Although the complication rate has been high, in dedicated teams and with proper selection of patients, replantation of infrapopliteal lower limb amputations can yield satisfactory results.