Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital

ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.

摘要
目的：本研究通过分析下肢复杂创伤的特征、类型、发生机制及演变过程，评估其诊疗策略，重点聚焦外科治疗方案。
方法：本研究为前瞻性研究，纳入联邦区某区域医院整形外科一年内收治的下肢创伤患者，通过系列临床评估及电话随访记录收集相关数据。
结果：本研究共纳入40例患者，平均年龄25.6岁，其中男性占比62.5%，为主要受试人群。最常见的创伤部位为下肢远端1/3（占比37.5%）。55%的患者存在骨或肌腱外露，35%的患者出现下肢骨折外露情况。本次研究采用的治疗手段包括：皮肤移植（57.5%）、局部筋膜皮瓣（15%）、肌皮瓣（12.5%）、交腿筋膜皮瓣、逆行腓肠肌皮瓣（12.5%）及显微外科皮瓣（2.5%）。短期疗效评估显示，35例患者疗效优良（占比87.5%），4例疗效一般（10%），1例疗效不佳（2.5%）。长期随访结果显示，18名完成问卷回访的患者中，10例在术后3个月内即可恢复行走（可借助辅助支具），占比55.6%。
结论：本研究显示，休闲时段因摩托车事故受伤的年轻男性为需接受手术重建的下肢创伤患者的典型人群，下肢远端1/3为最易受累的解剖区域。皮肤移植是最常用的创伤重建手术方式，术后功能评估结果表明，尽管患者创伤复杂，但绝大多数患者愈合过程顺利，功能恢复效果良好。