Limb salvage strategies for severe lower leg trauma complicated with necrotic infection
LIU Kun
LIU Lin-lin
MA Bing-tao
LI Tang-bo
QIAO Lin
ZHANG Shu-ming
XU Jian-qiang
Abstract：Objective To summarize the limb salvage strategies and treatment effects for severe lower leg trauma patients.The patients that were on the verge of amputation were combined with necrotic infection.Methods A retrospective study of 32 cases with severe Gustilo Ⅲb and Ⅲc injuries in lower legs was conducted.All were on the brink of amputation due to necrotic infection,and were treated by staged surgical strategy.In the first stage,infection was controlled through infection lesion clearance surgery,vacuum sealing drainage(VSD),and sensitive antibiotic treatment.In the second stage,microsurgical techniques were used to seal the wound through free skin flaps,pedicled skin flaps,and skin grafts.In the third stage,bone defects were repaired through external fixation and distraction osteogenesis.In the fourth stage,functional reconstruction was performed as needed,including Achilles tendon extension,tendon transposition,nerve repair,and ankle joint fusion.Observation indicators:success rate of limb salvage,function of limb,infection control time,flap survival,fracture healing time,treatment cycle,and major complications.Results Among the 32 cases,28 survived limb salvage,2 were amputated because of progressive necrosis of the distal limbs due to prolonged ischemia,1 was amputated due to uncontrollable life-threatening infection,and 1 died due to acute pulmonary embolism.The success rate of limb salvage was 87.5%.Among the 28 patients(successful limb salvage),8 had no obvious limping gait during daily walking,but could be seen limping during brisk walking;16 cases showed slight limping gait during walking,without the need for crutches;four cases showed significant limping and required walking with crutches.According to the Johner-Wruhs evaluation criteria for the treatment effect of tibial shaft fracture,there were 8 cases of excellent,16 cases of good,4 cases of fair,and 0 case of poor,with an excellent and good rate of 85.7%.There were no amputees who had survived limb salvage.The average Iowa knee joint function score was 90.8 points;the average Iowa ankle joint function score was 81.4 points.Infection control took an average of 15.5 days and required 2.4 lesion debridement surgeries.Survival status of flaps:all 28 flaps survived,with 18 completely survived in one surgery,and another 10 healed in the second stage after dressing change or debridement and skin grafting surgery due to edge necrosis.On average,it took 20.2 months from injury to the removal of the external fixation frame for fracture healing,and 31.2 months from injury to stable functional recovery.Main complications:all 28 cases with external fixation frame experienced varying degrees of nail path infections,which were improved after dressing change and antibiotic treatment.Among the 28 cases,22 underwent distraction osteogenesis treatment,and all 22 cases had soft tissue entrapment when the fracture ends were aligned.The fracture ends were cleaned and bone grafting surgery was performed.Among the 28 cases,11 had varying degrees of alignment deformities,including 6 cases of shortening,with an average shortening of 1.2 cm;5 cases of angular deformity,with an average angular angle of 6.5 degrees.Conclusions For Gustilo Ⅲb andⅢc injuries in lower legs that were on the brink of amputation due to necrotic infection after severe trauma,the use of multiple modern trauma treatment techniques and staged surgical treatment can still achieve a high survival rate of limb salvage and varying degrees of functional recovery.The disadvantages are long treatment cycles,multiple surgeries,high treatment costs,and incomplete functional recovery.
Keywords：Wounds and injuriesLegInfectionsLimb salvage
Publication Date：2025-03-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 207-213 )