In lower limb replantations late complications are frequent (partial necrosis, limb shortening, non-unions etc.). In our case series {from 1992 to 1999 - 14 cases on 12 patients - two bilateral) we had always limb length discrepancies, but in the two bilateral cases, due to the need of shortening to have a good replantation possibility. All replanted segments survived but we had to secondary amputate 5 cases for severe general complications. In the remaining cases, 4 had minimal bone loss (2-3 cm.) or symmetrical bone loss (bilateral cases). Two replanted segments presented a delayed union. In 5 patients a large bone loss was present (max 14 cm min 4 cm; mean 5.4 cm), requiring bone-lengthening. Even if in emergency external fixation could create some problem in replantations (bulky, need of very rapid fixation), in the following period it allows to solve two of the main problems in this surgery (non-unions, limb shortening). Secondary limb lengthening allows replantations even in the presence of big bone loss.
