Lower limb replantation: 27 years follow up (original) (raw)
Related papers
Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child
Case Reports in Orthopedics, 2015
Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a "Qing Qi" (motorcycle rickshaw). Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children.
Case Report Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child
2016
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Herewe present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi ” (motorcycle rickshaw). Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and reco...
Major limb replantation in children
Microsurgery, 1991
This retrospective study evaluated patients under 18 years of age who underwent major limb replantation between 1976 and 1989 at Louisville Hand Surgery. The age of the 15 patients followed for between 1 and 8.5 years (mean 4.2 years) ranged from 2 to 17 years (mean 9.8). Of amputations, 40% were guillotine, 40% were limited crush-avulsions, 7% were extended crushing, and eight were of an upper extremity and seven of a lower extremity. Average warm/total ischemia times were 4.8A4.8 hr in failures and 1.1/7.5 hours in successful replantation. Overall limb survival was 87%. Among the patients, 93% felt that their replanted limb functioned and looked better than a prosthesis; 87% of patients had a sensory recovery of more than S2 + in the lower extremity or S3 in the upper extremity: and 38% of upper extremity replantation patients had two-point discrimination of less than 15 mm.
Lower leg replantation—Decision-making, treatment, and long-term results
Microsurgery, 2007
Object: The aim of this article is to review the results of replantation at the lower leg after total and subtotal amputation injury. Although subtotal and total lower leg amputations have been successfully replanted in the past, nowadays there is a common opinion that these operations do not justify their efforts, and therefore most of those patients are amputated. Methods: To clarify this hypothesis we carried out an extensive literature research. The following criteria were evaluated: 1) survival rate, 2) individual motor and sensory functions and global lower extremity function judged according to the classification of Chen, 3) socioeconomic aspects (operation time, number of operations per patient, time of hospitalization, and return to normal life), and 4) number and nature of local and/or systemic complications. Results: The success rate of lower leg amputation, which only means perfect resortation of viability, is reported between 62.5% and 100%. Using Chen's classification the functional results can be given as follows: A ''functional extremity'' (grade I and grade II) can be reconstructed in 82.6% to 92.7%. A non-functional extremity (grade III and grade IV) will result in one tenth to one fifth of cases. Complications can be classified in local or systemic and occur depending on the quality of the decision-making process. Conclusion: Our results as well as those of other large series show that lower leg replantation is still worthwhile in a well selected patient group, contrary to what is believed by an increasing number of orthopaedic and trauma surgeons. V V C 2007 Wiley-Liss, Inc. Microsurgery 27:398-410, 2007.
Critical analysis of upper limb replantations
2006
Objective: The authors analyze the follow-up of results in 62 adult patients who had traumatic amputations in the upper limb and who underwent successful replantation procedures from 1994 to 2004. Methods: The levels of amputation were in fingers or thumb in 48, hand in 5, wrist in 4, forearm in 2 and arm in 3 patients. All patients were treated in a rehabilitation program of specialized hand therapy. A simplified questionnaire was used to evaluate the return to work activities using the operated limb, either in the formal or informal economy, and the patient’s satisfaction rate concerning the surgical procedure. Results: It was noted that 85.5% of patients returned to some work activity using the operated limb and 96.8% of patients are satisfied with the results. Conclusions: Patients submitted to successful replantation present a high rate of satisfaction and return to work activities.
Since the first successful salvage of an amputated finger using microsurgical anastomoses in 1965, replan-tation has been widely used in these decades and is now firmly established as a viable treatment option in traumatic limb amputation. The current concepts of replantation surgery for upper limb amputation are discussed in this review article in terms of history of replantation, present indications for the procedure, pre-theater care, technical refinements, postoperative management and functional outcome. In this article , we demonstrated that the advent of microsurgery has led to replantation of almost every amputated part of the upper limb possible. Replantation of digits and the hand can restore not only circulation but also function and cosmetic appearance. However, major amputations remain a challenge and the functional outcome is often disappointing, albeit the success rate of replantation exceeds 80%. Proper patient selection, adequate pre-theater preservation, good operative skill and postoperative care, as well as tight cooperation among the patient, the surgeon, and the rehabilitation therapist will help to achieve a better final functional outcome.
Critical analysis of upper limb replantations Análise crítica dos reimplantes no membro superior
Objective: The authors analyze the follow-up of results in 62 adult patients who had traumatic amputations in the upper limb and who underwent successful replantation procedures from 1994 to 2004. Methods: The levels of amputation were in fingers or thumb in 48, hand in 5, wrist in 4, forearm in 2 and arm in 3 patients. All patients were treated in a rehabilitation program of specialized hand therapy. A simplified questionnaire was used to evaluate the return to work activities using the operated limb, either in the formal or informal economy, and the patient's satisfaction rate concerning the surgical procedure. Results: It was noted that 85.5% of patients returned to some work activity using the operated limb and 96.8% of patients are satisfied with the results. Conclusions: Patients submitted to successful replantation present a high rate of satisfaction and return to work activities.
Rehabilitation in a patient with replantation of amputated distal leg
Mædica, 2011
Many studies have been reported on replantation of an upper extremity after traumatic amputation, but there are only a few case reports on replantation of the lower extremities rather than amputation surgery. This is due to preoperative factors, complications and the possibility of good prosthetic substitution.We describe here the dynamic evaluation necessary for a continuous rehabilitation treatment in a subject with replanted left foot after traumatic amputation. A 58-year-old male person with amputation of the left leg at the level of the left talocrural joint, with talar dome and bimalleolar fractures and complete section of the blood vessels, nerves and tendons was considered for replantation surgery 7 hours after a traumatic injury.For an accurate evaluation of the postoperative conditions over time, clinical functional assessment combined with imaging and neurophysiological examination were conducted.Rehabilitation program is aimed to train the motor and sensory function of t...
Lower limb amputation Part 2: Rehabilitation ‐ a 10 year literature review
Prosthetics and Orthotics International, 2001
Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitationprosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and four (104) articles were assessed by reading and from these the authors selected 24 articles. These articles are summarised, under several subheadings in this review article, focussing especially on quality of life, functional outcome and predictive factors. 14 Prosthet Orthot Int Downloaded from informahealthcare.com by 171.101.128.123 on 05/20/14 For personal use only.