Ten years retrospective study of using primary microsurgery technology to treat patients with severe lower extremities injury

Objective To clarify the role of microsurgery in limb salvage procedure and its efficiency in longterm functional results through a retrospective review of patients who sustained severe injury of lower extremities and had been treated Shanghai 6th people's hospital, in recent 10 years. Methods Patients who sustained severe injury of lower extremities and treated with microsurgical techniques in January, 2006 to January, 2016 were studied. Patients' general information, classification of open fracture, and MESS were noted. The enrolled patients were divided into two groups(group A: primary microsurgical reconstruction; group B: non-microsurgical reconstruction) according to whether primary microsurgical reconstruction was performed or not. Each group were also further divided into subgroup according to preoperative MESS(MESS<7 and MESS≥7). The reconstruction methods, hospitalization days, operation times, postoperative complications, as well as the SIP were then recorded for each groups. The differences of these data among each groups were analyzed and compared. Results The main objection was patient with Gustilo grade III open fracture, totally 548 patients were admitted, with 312 males and 236 females. The main age was 35.6 years old. The main etiology was road traffic accident (79.7%). There were 211 patients (38.5%) in group A, and 337 patients (61.5%) in group B. In group A, there were 37 patients in subgroup one (MESS<7), and 174 patients in subgroup two(MESS ≥7). The rate of delayed amputation was 2.8%, while the complication rate was 11.8%. In group B, there were 181 patients in subgroup one(MESS<7), and 156 patients in subgroup two (MESS≥7). The rate of delayed amputation was 4.0%, while the complication rate was 13.3%. In long-term survey, the average VAS score of group B was higher than that of group A, but no significant difference was noted. The average VAS scores in 2 year postoperatively in the subgroups (MESS≥7) were higher than those in the other subgroups(MESS<7). The results of SIP scores were similar with VAS scores in two groups. Conclusion The techniques of microsurgery has been promoting the successful rates and outcomes for limb salvage procedure over the recent decades. Meanwhile, the current evaluating system for severe limb injury needs to be updated to meet the demands of ever-developing limb salvage techniques. Key words: Severe lower limb injury; Limb salvage; MESS; Microsurgical technique