Evaluation Of 2 Stages Reconstruction for Mangled Extremity by Using A First Stage Acute Shortening Followed by A Second Stage Lengthening
Authors: Zhu Fenghua , Zhang Qiushun , Zhang Qinming , Li Xingwei , Liu Changying , Wang Haibin , Qiu Jinya , Zhao Yifeng 
Published: December 2024

PURPOSE：Evaluation Of 2 Stages Reconstruction for Mangled Extremity by Using A First Stage Acute Shortening Followed by A Second Stage Lengthening.
METHODS：Retrospective analysis of 8 cases of mangled extremity patients admitted to the Department of Traumatology and Orthopaedics of the Affiliated Hospital of Jining Medical University from February 2016 to October 2023, 8 male, 0 female; age 31-51 years old, average age 40.4 years old; 5 cases of calf, 2 cases of thigh, and 1 case of upper arm. The average length of bone defect was 8.3 (0-15.1) cm, and the average length of mangled muscle was 7.4 (4.0-15.0) cm; the major blood vessels of all limbs were severed and needed to be repaired in order to preserve the limbs; all injured limbs had abnormal sensation at the end of the limb, and most of the patients had sensory loss of the injured limb; all injured limbs had a large area of skin defect or degloved skin injury; The average MESS score was 9.1 (6-12), and only one case was below 7. All of them were fixed with temporary external fixation braces in the first stage for large segmental shortening and replantation of a severed limb, and Ilizarov limb lengthening technique was applied in the second stage for lengthening and reconstruction of shortened limbs, and after both lower limbs were isometric and the lengthening bone was mineralized satisfactorily, the unilateral external fixatorwere removed to perform weight-bearing exercises. For patients with obvious equinus foot deformity, they should be fixed with Ilizarov ring external fixation frame, and the equinus foot should be pulled and corrected, after the orthopedic deformity is satisfied, they should continue to wear the fixation frame for walking exercise for 1-2 months, and then the external frame should be dismantled. Finally, the patients were observed the recovery of the adjacent joint function, sensory recovery of the end of the limb, and the recovery of the limb length.
RESULTS: All 8 patients were followed up after surgery for 13-69 months, mean 38.0 months. The average stage I limb shortening was 7.1 (4.0-15.1) cm, and the average healing time of the traumatized surface was 13.6 (5-23) weeks. All patients replantation of a severed limb was successful with good survival. Ilizarov lengthening technique was applied to lengthen and reconstruct the shortened limbs in the second stage, and the average length of bone lengthening was 10.4 (4.0-15.1) cm(excluding special cases 1 and 2). Except for one case of upper arm, in which the limb was shorter than the contralateral side by 2 cm, the rest of the limbs reached isometric length. The average bone healing index was 2.83 (1.67-3.44) m/cm. 7 cases of lower limbs (5 calves, 2 thighs) had normal knee joint function, 1 case (with a shorter bone defect of 4 cm) had normal ankle joint function, and the remaining 6 cases had varying degrees of equinusfoot deformity, of which 3 cases were successfully corrected by pulling on the Ilizarov ring external fixation bracket, and 3 cases were corrected by wearing a brace. One upper arm patient had complete recovery of limb function and end-of-limb sensation, and the rest of the lower limb patients had mostly recovered plantar sensation. The ASAMI (the Association for the Study and Application of Methods of Ilizarov) scores, functional ratings and bone healing ratings of the patients were mostly excellent.
CONCLUSIONS: mangled extremity can obtain good limb preservation by applying phase I shortening technique, and most of the patients can obtain better limb function by applying Ilizarov limb lengthening reconstruction technique in phase II.