[Staged comprehensive limb reconstruction strategy and effectiveness analysis for severe open lower leg injury]

To investigate the effectiveness and safety of a staged comprehensive limb reconstruction strategy for severe open lower leg injury.

A retrospective analysis was performed on clinical data of 10 patients with severe open lower leg injury accompanied by large segmental bone defects, extensive soft tissue destruction and neurovascular injuries treated between October 2020 and February 2025. There were 8 males and 2 females with an average age of 50.1 years (range, 18-65 years). The causes of injuries included traffic accident in 6 cases, falling from height in 1 case, and machine crush in 3 cases. The injuries were classified as Gustilo type ⅢB in 6 cases and type ⅢC in 7 cases. The size of tissue defect ranged from 7 cm×3 cm to 18 cm×15 cm. The interval between injury and admission ranged from 2 to 8 hours (mean, 4.6 hours). All patients received a three-stage sequential reconstruction protocol. In the emergency early stage, thorough debridement, neurovascular anastomosis, temporary external fixation combined with vacuum sealing drainage (VSD) were performed to rapidly control injury, restore limb perfusion, and stabilize the extremity. In the intermediate stage, precise debridement was conducted to manage wound infection, and soft tissue coverage was achieved via skin grafting and flap transplantation. In the final stage, Ilizarov circular external fixator was applied to implement bone transport, bone grafting, limb lengthening, as well as release and correction of foot and ankle deformities. Individualized rehabilitation training was administered to restore limb function. Perioperative complications, bone healing parameters, and limb length recovery were recorded. The Paley bone healing and functional scoring system was adopted to evaluate overall outcomes at last follow-up.

All 10 patients successfully completed the staged treatment and were followed up. The follow-up time ranged from 13.1 to 37.0 months (mean, 20.6 months). Among the 10 patients, 9 patients achieved bone union after bone transport; 1 patient attained bone union following autologous iliac crest bone grafting. The duration of bone transport was 1.3-5.2 months (mean, 2.6 months). Three patients developed pin tract infections, which resolved after routine dressing change and symptomatic management. The time of bone union were 6.1-32.8 months (mean, 15.0 months). At last follow-up, the Paley evaluation showed excellent results in 7 cases, good in 2 cases, and fair in 1 case. All patients regained the ability of independent walking and weight-bearing of the affected limb. The residual limb shortening ranged from 0.4 to 1.8 cm, with a mean of 0.9 cm.

The staged comprehensive limb reconstruction strategy for severe open lower leg injury enables sequential revascularization, soft tissue repair, bone defect reconstruction, and limb deformity correction. It can effectively control complications, reduce the risk of amputation, and restore the anatomical integrity and motor function of the affected limb.