Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

Orthopaedic Surgery
Nicholas KusnezovMiguel A Pirela-Cruz

Abstract

In the setting a near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, ...Continue Reading

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Citations

Jul 8, 2016·Orthopaedic Surgery
Aug 24, 2019·The Journal of Hand Surgery Asian-Pacific Volume·Luis SchnappRodrigo N Banegas
Mar 7, 2021·European Journal of Orthopaedic Surgery & Traumatology : Orthopédie Traumatologie·Nando FerreiraMaritz Laubscher

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