{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T06:10:28Z","timestamp":1759471828238,"version":"build-2065373602"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Central Guiding Local Science and Technology Development Special Fund Project","award":["ZYYD2022A03, 2022"],"award-info":[{"award-number":["ZYYD2022A03, 2022"]}]},{"name":"Tianshan Talent Technology Innovation Leading Talent\u2014High-Level Leading Talent Project","award":["2022TSYCLJ0026, 2022"],"award-info":[{"award-number":["2022TSYCLJ0026, 2022"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to evaluate the outcomes of limb lengthening based on the Ilizarov technique in the treatment of limb shortening following successful replantation of traumatic lower leg amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The clinical records and consecutive x-ray photographs of patients with limb shortening deformities following successful replantation of traumatic lower leg amputation treated by limb lengthening using an external fixator were analyzed retrospectively, from January 2012 to December 2022. The demographic data, initial injury, previous treatment, and postoperative data were collected. Paley classification was applied to assess the bone and functional outcomes. The lower extremity functional scale (LEFS), visual analog scale (VAS), and 36-item Short Form Health Survey of life quality (SF-36) were used to evaluate and compare the results of the affected limbs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 21 patients with a mean age of 42.71\u2009\u00b1\u20097.96 years, consisting of 17 males (80.9%) and 4 females (19.1%), were successfully treated by limb lengthening using an external fixator. The mean length of limb shortening after limb replantation is 9.93\u2009\u00b1\u20092.88\u2005cm. The mean external fixation time of this cohort was 16\u2009\u00b1\u20095.27 months, with a mean external fixation index of 1.59\u2009\u00b1\u20090.14 month\/cm. In bone results, there were 14 cases in excellent, and 6 cases in good, with an excellent and good rate of 95.2%. In functional results, there were 15 cases of excellent, and 5 cases of good, with an excellent and good rate of 95.2%. The knee joint displayed an average over-extension range of motion of 2.9\u2009\u00b1\u20090.85\u00b0 (0\u00b0\u20135\u00b0), with an average flexion range of 114.7\u2009\u00b1\u20093.05\u00b0 (105\u00b0\u2013140\u00b0). Among the patients, except for the 2 cases of tenodesis, the remaining individuals exhibited an average plantar flexion of 23.2\u2009\u00b1\u20093.34\u00b0 (10\u00b0\u201340\u00b0) and an average dorsiflexion of 15.1\u2009\u00b1\u20093.44\u00b0 (10\u00b0\u201325\u00b0). The outcomes of plantar sensation recovery were as follows: 6 cases were classified as S3<jats:sub>+<\/jats:sub>, 11 cases as S3, and 4 cases as S2. The LEFS and SF-36 scores followed a characteristic \u201cV\u201d-shaped trajectory, initially declining before subsequently increasing (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). VAS scores generally showed a trend opposite to that of the LEFS functional scores (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Limb lengthening based on the Ilizarov technique was a safe and effective method for treating shortening following successful replantation of traumatic lower leg amputation, and it could yield satisfactory postoperative bone and functional results. The long treatment period usually associated with this method increases the risk of complications, necessitating good patient compliance with meticulous postoperative management and follow-up guidance to minimize these risks.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1686865","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T05:29:12Z","timestamp":1759469352000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of limb lengthening as a treatment for shortening following successful replantation of traumatic leg amputation: experience with 21 patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Caifeng","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shengquan","family":"Ren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoheng","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aihemaitijiang","family":"Yusufu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1097\/00005373-198808000-00023","article-title":"The medical and economic impact of severely injured lower extremities","volume":"28","author":"Bondurant","year":"1988","journal-title":"J Trauma"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3555","DOI":"10.1016\/j.injury.2021.03.028","article-title":"Mangled extremity- modern concepts in treatment","volume":"52","author":"Bumbasirevic","year":"2021","journal-title":"Injury"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e94","DOI":"10.2106\/JBJS.18.01302","article-title":"Establishing an evaluation system and limb-salvage protocol for mangled lower extremities in China","volume":"101","author":"Lu","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1186\/s12891-024-07377-2","article-title":"Treatment of tibial bone defects caused by infection: a retrospective comparative study of bone transport using a combined technique of unilateral external fixation over an intramedullary nail versus circular external fixation over an intramedullary nail","volume":"25","author":"Maimaiti","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e33589","DOI":"10.1016\/j.heliyon.2024.e33589","article-title":"Comparing clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries: a long-term study protocol","volume":"10","author":"Yang","year":"2024","journal-title":"Heliyon"},{"key":"B6","first-page":"E27","article-title":"Updates in the management of orthopedic soft-tissue injuries associated with lower extremity trauma","volume":"41","author":"Park","year":"2012","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s10439-020-02665-z","article-title":"Mechanobiology of bone consolidation during distraction osteogenesis: bone lengthening vs. bone transport","volume":"49","author":"Blazquez-Carmona","year":"2021","journal-title":"Ann Biomed Eng"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s10195-019-0541-3","article-title":"Limb lengthening history, evolution, complications and current concepts","volume":"21","author":"Hosny","year":"2020","journal-title":"J Orthop Traumatol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1016\/j.injury.2023.01.029","article-title":"Acute shortening and double-level lengthening versus bone transport for the management of large tibial bone defects after trauma and infection","volume":"54","author":"Huang","year":"2023","journal-title":"Injury"},{"key":"B10","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/00003086-198901000-00038","article-title":"The tension-stress effect on the genesis and growth of tissues. 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