Survival and secondary surgery following lower extremity replantation

Background The limited and inconsistent literature exists on survival and secondary surgery following lower limb replantation. The purpose of this study was to review our institutional experience in lower extremity replantation to quantify survival and characterize secondary surgeries. Methods We performed a retrospective chart review of all lower extremity replantations at our institution between 2000 and 2012. The mean follow-up period was 2.6 years. Patient, injury, and surgical demographics as well as replantation survival, secondary surgical procedures, and complications were recorded. Results A total of 22 lower extremity replantations were performed with 45% survival (n=10). Secondary surgeries were common with an average of six per patient (range 2-11). Early secondary procedures included debridements (19 of 22 patients, 86%) and soft tissue coverage (15 of 22 patients, 68%). The average initial hospitalization was 45 days (range 19-90) and time to final secondary procedure in patients with surviving replantation was 1.5 years (range 18 d-3.5 y). Late secondary surgeries were aimed at either aesthetic or functional enhancement. The most common complication was deep infection in 18 of 22 patients (82%) and infection was felt to be the cause of replantation failure in all cases. Conclusion We found a modest survival following lower extremity replantation with several secondary surgeries in each case. Infection complicated the majority of cases and free tissue transfer was often required for wound coverage. Early secondary surgeries were aimed at debridement and soft tissue coverage while late secondary surgeries were aimed at either aesthetic or functional enhancement.