作者：Duretti Fufa, Cheng-Hung Lin, Yu-Te Lin, hung-Cheng Hsu, Chih-Hung Lin
文章發表：J Reconstr Microsurg. 2014 Jul;30(6):419-26
大綱：
一、背景: 關於下肢再植後的存活和二次手術的文獻有限且不一致。 這項研究的目的是回顧我們在下肢再植方面的機構經驗，以量化生存率和表徵二次手術。二、方法: 我們對我們長庚醫院在2000年至2012年之間進行的所有下肢再植進行了回顧性圖表審查。平均觀察期為2.6年。 記錄患者，受傷情況和外科手術的人口統計學信息，以及再植存活率，二次外科手術程序和併發症。三、結果: 總共進行了22次下肢再植，存活率為45％（n = 10）。 二次手術很普遍，平均每位患者六次（範圍2-11）。 早期次要手術包括清創術（22例中的19例，佔86％）和軟組織覆蓋（22例中的15例，佔68％）。 存活再植的患者的平均初始住院時間為45天（範圍為19-90），到最終第二次手術的時間為1.5年（範圍為18 d-3.5 y）。 晚期二次手術的目標是美觀或功能增強。 最常見的併發症是22例患者中的18例（82％）發生深部感染，並且在所有情況下，感染都被認為是再植失敗的原因。四、結論：我們發現下肢再植後的存活率適中，每種情況下都進行了幾次二次手術。 感染使大多數病例變得複雜，傷口覆蓋通常需要自由組織轉移。 早期的二次手術的目的是清創術和軟組織覆蓋，而晚期的二次手術的目的是美觀或功能增強。
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
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