[Replantations and devascularization. VBS (Vessel-Bone-Skin) emergencies]

The reimplanting activity initiated by Professor Raymond Vilain at Boucicaut Hospital in 1972 allowed emphasizing that, in addition to the reimplantation of a completely severed segment, there existed a parallel activity including microsurgical steps, bone surgery and skin plasties, all of which were gathered under the term of VBS, or Vessels-Bone-Skin, emergencies. Other terms are used (stage 3 fracture with vascular involvement, stage 4 fracture) for the same ultra-emergent pathology, in which many diagnostic problems as to the significance and extent of ischemia are associated with therapeutic issues. The results of an operation performed by one surgeon possessing all the desirable skills and working in a specialist Center allowed demonstrating that the quality of the results was such as could be hoped for: an overall survival rate of about 60%, little second surgery, blood consumption lower than 10 bottles per patient in average. These data represent the major progress made in 15 years. However, the rescuing staff must still be made aware of the importance of diagnosing devascularization in a context of multiple injuries: a VBS emergency involves limbs in which bony continuity, and sometimes even a skin bridge, may still be preserved. The vascular problems cannot be solved without resorting to the microanastomosed flap techniques. Lastly, the staff in charge of this kind of problems must treat upper limbs as well as lower limbs. Utmost surgical strictness is essential to avoid the major complication of such surgery: not only local failure threatening the functional results, but also the vital risks inherent in the reimplantation of a large limb segment. Reimplantation of an autologous limb has largely demonstrated its superiority over prostheses, even the most sophisticated ones.