[Formation of functional stumps of the extremities in severe mechanical trauma]

The authors analyze the treatment of 54 patients with 65 limb stumps resultant from injuries to the limbs in 41 patients shortly exposed to traumatic agents and in 13 patients after a prolonged crushing of the limb during the earthquake in Armenia. Amputations were carried out as primary surgical wound treatment followed by open healing of the wound. To prevent infections, 12 patients were treated with the use of a local gnotobiologic isolation, the rest by traditional methods with due consideration for the wound process. Local treatment of stump wounds in the patients with the crush syndrome involved some specific measures because of massive necroses and deep suppuration. For the early formation of functional stumps of the limbs, wound treatment was followed by reconstructive surgery by closing the stump wound defect with massive removed skin and subcutaneous fat flaps and subsequent active drainage of the wound. Postoperative treatment was aimed at improving the microcirculation in the skin grafts. The status of the stump soft tissues and bone was assessed over the course of treatment by limb scintigraphy with 99mTc-labeled pyrophosphate. Such investigation helps determine the optimal terms for reconstructive surgery and predict its outcome. Good results were achieved: 80.6% of patients were supplied with prostheses within 3-4 months after the injury.