ABSTRACT
The replantation of large limb segments presents two major problems: first, a general
danger to survival because of major accompanying injuries and additional ischemia-reperfusion
injury; second, local soft-tissue damage at the amputation site. Successful replantation
can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible
risk reduction may be accomplished by the concept of a two-staged replantation. A
brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization
(with the goal of limb survival) is followed by a second procedure within 72 hr after
trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing,
and soft-tissue coverage by free flaps. The advantages of the double procedure are
demonstrated in 27 patients by comparison of two treatment groups. Group 1 comprised
15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation
was performed. The second group showed a shorter duration of overall treatment, reduction
of blood loss, and fewer infections.
