Reconstructive surgeries of below-knee amputation stumps resulting from combat trauma

Abstract

Background. Full-scale military operations are accompanied by an increase in the number of wounded with severe limb injuries, often requiring amputation. Despite advances in surgical technology, a significant proportion of patients develop pathologically altered stumps after lower limb amputation, complicating prosthetics and further rehabilitation. Aim: to improve the effectiveness of reconstructive and restorative treatment of patients with lower limb amputation stump defects after combat trauma by improving amputation plastic surgery techniques. Materials and methods. Clinical examination and surgical treatment were performed on 126 patients with lower limb amputation stump defects, among which post-traumatic lesions caused by mine-blast and gunshot wounds prevailed. A total of 137 reconstructive surgical procedures were performed, including myoplastic, osteoplastic, and skin-subcutaneous operations. Radiographic, ultrasonic, and histological methods were used to evaluate the outcomes. The duration of follow-up ranged from 3 months to 5 years. Results. All patients achieved stable positive results with the formation of an elastic, painless and functionally complete stump suitable for modern prosthetics. The use of developed and improved methods of skin, muscle and bone plastic surgery contributed to an increase in stump stability, uniform load distribution in the prosthesis socket and a reduction in the percentage of defective stumps. Conclusions. Closure of defects with skin and subcutaneous flaps is the method of choice for reconstructing amputation stumps of the lower leg after combat injuries. Fixing muscles to the bone allows you to eliminate stump defects and obtain an elastic muscle stump. The formation of interosseous synostosis using various osteoplastic methods significantly improves the functional properties of the stump and contributes to effective prosthetics.