Outcome of limb lengthening as a treatment for shortening following successful replantation of traumatic leg amputation: experience with 21 patients

Caifeng Wu¹Kai Liu²Shengquan Ren³Mingming Liu⁴Xiaoheng Ding³Aihemaitijiang Yusufu^5*

• ¹The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
• ²The Affiliated Hospital of Southwest Medical University, Luzhou, China
• ³The Affiliated Hospital of Qingdao University, Qingdao, China
• ⁴971st Hospital of the Chinese People's Liberation Army Navy, Qingdao, China
• ⁵First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

Objective: The purpose of this study was to evaluate the outcomes of limb lengthening based on the Ilizarov technique in the treatment of limb shortening following successful replantation of traumatic lower leg amputation. Methods: The clinical records and consecutive X-ray photographs of patients with limb shortening deformities following successful replantation of traumatic lower leg amputation treated by limb lengthening were analyzed retrospectively, from January 2012 to December 2022. The demographic data, initial injury, previous treatment, and postoperative data were collected. Paley classification was applied to assess the bone and functional outcomes. The lower extremity functional scale (LEFS), visual analog scale (VAS), and 36-item Short Form Health Survey of life quality (SF-36) were used to evaluate and compare the results of the affected limbs. Results: A total of 21 patients with a mean age of 42.71 ± 7.96 years, consisting of 17 males (80.9%) and 4 females (19.1%), were successfully treated by limb lengthening. The mean length of limb shortening after limb replantation is 9.93 ± 2.88 cm. The mean external fixation time was 16 ± 5.27 months, with a mean external fixation index of 1.59 ± 0.14 month/cm. In bone results, there were 14 cases in excellent, and 6 cases in good. In functional results, there were 15 cases of excellent, and 5 cases of good. Among the patients, except for the 2 cases of tenodesis, the remaining individuals exhibited an average plantar flexion of 23.2 ± 3.34° (10° to 40°) and an average dorsiflexion of 15.1 ± 3.44° (10° to 25°). The LEFS and SF-36 scores followed a characteristic "V"-shaped trajectory, initially declining before subsequently increasing (P <0.05). VAS scores generally showed a trend opposite to that of the LEFS functional scores (P <0.05). Conclusion: Limb lengthening based on the Ilizarov technique was a safe and effective method for treating shortening following successful replantation of traumatic lower leg amputation, and it could yield satisfactory postoperative bone and functional results. The long treatment period usually associated with this method increases the risk of complications, necessitating good patient compliance with meticulous postoperative management and follow-up guidance to minimize these risks.