New insights in lower limb reconstruction strategies

Abstract

High Energy Musculoskeletal Traumas (HEMTs) represent a relevant problem for healthcare systems, considering the high social costs, and both the high morbidity and mortality. The poor outcomes associated with HEMT are related to the high incidence of complications, including bone infection, fracture malunion and non-union. The treatment of each of these complications could be extremely difficult. Limb reconstruction often needs multiple procedures, rising some questions on the opportunity in perseverate to try to save the affected limb. In fact, theoretically, amputation may guarantee better function and lower complications. However, amputation is not free of complication, and a high long-term social cost has been reported. A comprehensive literature review was performed to suggest possible ways to optimize the limb preservation surgeries of HEMT’s complications in order to ameliorate their management.

Distribution of pathogens and risk factors for post-replantation wound infection in patients with traumatic major limb mutilation

“…Traumatic major limb mutilation is one of the main causes of limb loss. Even though replantation of limb mutilation is increasing gradually with the development of microsurgery and surgical techniques [ 1 , 4 , 27 ], postoperative wound infection can result in multiple operations and even delayed amputation, which may increase the financial and psychological burden of patients [ 2 , 4 , 16 ]. This study found that postoperative wound infection was common in patients with severe traumatic major limb mutilation, and most of the pathogenic bacteria were multi-drug resistant bacteria, which was associated with ischemic time, degrees of wound contamination, stress hyperglycemia, and MESS.…”

“…High energy trauma such as traumatic mutilation of major limbs was the leading cause of amputation and can be life-threatening [1][2][3]. With the development of surgical techniques, the limbs saving rate of patients gradually increased [1,4], however, with the aggravation of trauma severity, the incidence of postoperative complications also gradually increased [2,5,6]. Postoperative wound infection is one of the most common complications after surgery [7,8].…”