Clinical selection of limb-salvage treatment options for mutilated forearm

Abstract

Objective To investigate prerequisites and surgical techniques of limb-salvage treatment in patients with mutilated forearm injuries. Methods From March 2009 to September 2014, a total of 15 cases of mutilated injuries of the forearm were treated with limb-salvage procedures according to injury conditions. After debridement and exploration, vascular and nerve defects were repaired with vein and nerve grafts, respectively. Bone fractures were fixed with locking plate internal fixation or external fixators. Soft tissue defects were covered with flaps and vacuum sealing drainage techniques were applied for promotion of wound healing. Results Among the 15 cases, limb salvage failed in 2 cases. The mutilated limb was successfully preserved in the rest 13 cases where second-stage wound management was needed. There were 5 cases with nonunion and 2 cases with osteomyelitis. Multiple surgical debridement, bone grafting and functional reconstruction were carried out to restore some of the functions in these patients. These 13 cases were follow-up for 6 months to 5 years. The appearance and function of the forearms and hands were satisfactory. Pain sensation and deep touch sensation were preserved. Conclusion Proper judgment of the extent of the injury and microsurgical repair of vessels and nerves along with secondary functional reconstruction can salvage limbs that are mutilated and restore some hand functions. Key words: Forearm injuries; Microsurgery; Limb salvage; Repair