Journal of reconstructive microsurgery
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J Reconstr Microsurg · Nov 2010
Case ReportsReplantation of above-knee amputation: a surviving but dysfunctional case needing secondary amputation.
Above-knee amputations are rare injuries that need emergent replantation or primary amputation. Although survival could be achieved in selective cases, postoperative function of the affected limb is usually unsatisfactory and a late amputation has to be performed for poor prognosis or severe complications. Experience of the surgical team may play an important role in primary decision making, which leads us to report one case of above-knee replantation with poor postoperative function and needing a late amputation. Scoring systems, expected results based on our case, and a brief review of literature concerning above-knee replantations are discussed.
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J Reconstr Microsurg · Jul 2010
ReviewWhich end is up? Terminology for terminolateral (end-to-side) nerve repair: a review.
By convention, we "come from" and "go to." A flap has a donor site and goes to a recipient site. A transplant comes from a donor and goes to a recipient. Neural regeneration proceeds from proximal to distal. ⋯ The full descriptive phrase must include whether the intent is to reinnervate a skin target and is, therefore, a sensory repair, or to reinnervate a motor target. The names of both the donor and the recipient nerves must be specified. Illustrations of these logical possibilities are shown in this review of the modern history of "end-to-side" or "side-to-end" nerve coaptations.
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J Reconstr Microsurg · Nov 2009
Outcomes of microvascular reconstruction of single-vessel lower extremities: limb salvage versus amputation.
Many patients with complex wounds on single-vessel lower extremities undergo amputation. Limb salvage using microvascular reconstructive techniques is an alternative in these patients that can preserve ambulatory status, but data focused on reconstruction in the single vessel population have been limited. A retrospective review of all microvascular lower-extremity reconstructions from August 2003 to December 2008 was performed. ⋯ There were two complications, a hematoma and a case of flap success followed by reactivation of osteomyelitis 3 months after the free flap procedure resulting in below-knee amputation. The ultimate goal of limb salvage is to maximize limb length in an effort to prevent an increase in the energy of ambulation. Using microvascular reconstructive techniques, it can be performed successfully and with the majority of patients regaining an ambulatory status.
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J Reconstr Microsurg · Jun 2009
Case ReportsSimultaneous replantation of both lower legs in a child: 23 years later.
Function is the single most important determinant in the assessment of the results of extremity replantations. Accordingly, the indications for extremity replantations are based on the prediction of sustained satisfactory functional outcome. ⋯ However, this analysis is extremely important in refinement of indications for major limb replantations. In this article, evaluation of a patient 23 years after simultaneous replantation of both lower legs is presented.