Results of ankle replantation procedure: a case series and review of the literature

Introduction: The ankle replantation procedure was still a controversial topic due to overall poor results and a high complication rate. However, in some suitable cases, the procedure may be indicated. The objective of this report was to evaluate the outcomes of the ankle replantation procedure in a series of six cases. Presentation of cases: This retrospective case series included six male patients aged 19–54 years who underwent ankle replantation between January 2015 and February 2017. The injuries consisted of four subtotal amputations and two complete amputations. Short-term outcomes demonstrated the survival of all replanted ankles. Soft-tissue necrosis occurred in two cases, and one patient required a postoperative blood transfusion. Long-term outcomes revealed bone shortening in five cases and recovery of plantar sensation in all patients. According to the Chen classification, functional outcomes were grade I (excellent) in one case, grade II (good) in four cases, and grade III (fair) in one case. Discussion: Ankle replantation may offer favorable outcomes because the limited muscle mass and anatomical characteristics of the ankle facilitate surgical repair and reduce complications. In carefully selected patients with a Mangled Extremity Severity Score <7, an intact plantar surface, a repairable tibial nerve, and limited soft-tissue injury, ankle replantation may provide better functional outcomes than prosthetic reconstruction. Conclusion: In cases of traumatic ankle amputation, careful patient selection and thorough anticipation of potential complications are essential to achieve satisfactory outcomes.