Mantas Fomkinas¹, Karolina Staškevičiūtė¹, Gediminas Samulėnas²

 

¹ Lithuanian University of Health Sciences, Academy of Medicine, A. Mickevičiaus st 9, LT 44307, Kaunas, Lithuania

² Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Department of Plastic and Reconstructive Surgery, Eivenių st 2, LT 50009 Kaunas, Lithuania

 

Abstract

Limb injuries are one of the most common injuries in emergency medicine and surgery practice. Non-fatal lower limb injuries are one of the most common causes of hospitalization, more than a third of which are severe and may require amputation. High energy injuries can cause complex bone and soft tissue injuries and damage blood vessels and nerves. The main goal of the treatment is to restore the integrity and function of the limb, to ensure stable osteosynthesis and reconstruction of soft tissues. Consequently achieving the best outcome requires an assessment of the patient’s condition and the extent of the injury, thorough wound debridement and ensuring perfusion. This requires careful work by a multidisciplinary team of specialists and taking into account patient’s comorbidities, injuries, wound preparation, osteosynthesis capabilities and the availability of the donor tissues. Osteosynthesis can be achieved by a variety of metal devices, depending on the location and the type of the fractures. Gustilo – Anderson classification type I – IIIa injuries may be repaired by primary wound closure, type IIIb or IIIc injuries with skin defects, protruding bones or tendons may require more complex interventions – local, regional or free tissue flaps. The main goals of soft tissue reconstruction are to cover tissue defects, ensure an acceptable appearance and to cause minimal injury to the donor site. Therefore, the choice of reconstruction method depends on the area and extent of the injury and the patient’s risk factors. The lower limb may be salvaged when expected functionality of the reconstructed limb might be higher compared to the amputated limb. If it is not possible to ensure, then limb amputation is chosen, preserving the functionally more favorable length of the remaining limb for prosthesis application. Sometimes lower limb injuries are so severe that limb amputation is necessary to save patient’s live.

Keywords: lower extremity, lower limb, leg, trauma, injury, osteosynthesis, reconstruction.