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Related Experiment Videos

Are type IIIC lower extremity injuries an indication for primary amputation

T E Quirke1, P K Sharma, W K Boss

  • 1Department of Plastic and Orthopedic Surgery, University of Medicine and Dentistry of New Jersey-Newark 07103, USA.

The Journal of Trauma
|June 1, 1996
PubMed
Summary

Severe lower extremity fractures (Gustilo Type IIIC) can be treated with a 93% success rate through immediate revascularization and delayed wound closure. This approach prioritizes limb salvage over immediate amputation for eligible patients.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Microsurgery

Background:

  • Severe open lower extremity fractures pose significant challenges for limb salvage.
  • Limited data exists on long-term outcomes for Gustilo Type IIIC injuries.

Purpose of the Study:

  • To report the long-term results of a specific treatment protocol for severe devascularized open lower extremity fractures (Gustilo Type IIIC).
  • To detail the management strategy that achieved a high success rate in limb revascularization.

Main Methods:

  • Retrospective review of 35 consecutively admitted patients with Gustilo Type IIIC injuries.
  • Analysis of treatment protocols including immediate revascularization, vein grafting, external fixation, microsurgical free flaps, bone grafting, and delayed wound closure.
  • Comparison of outcomes between primary amputation (21 patients) and revascularization (14 patients).

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Main Results:

  • A 93% success rate in limb revascularization was achieved in 14 patients with Type IIIC injuries.
  • The protocol involved immediate revascularization, vein grafts, external fixation, microsurgical reconstruction, and delayed definitive wound closure (4-6 weeks).
  • Contraindications included poor pre-injury health, complete limb severance, extensive segmental bone loss, prolonged ischemia time, and posterior tibial nerve severance.

Conclusions:

  • An aggressive revascularization strategy with delayed wound closure can achieve high limb salvage rates for selected Gustilo Type IIIC fractures.
  • Careful patient selection based on specific contraindications is crucial for successful outcomes.
  • This approach minimizes ischemia time and manages reperfusion injury effectively.