Are type IIIC lower extremity injuries an indication for primary amputation

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).

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.