Ten-year outcome of unilateral leg replantation after bilateral lower leg amputation following traumatic injury: A case report. (April 2022)

• Record Type: Journal Article
• Authors: Fujimura, Ryo; Adachi, Keisuke; Shitozawa, Hisakazu; Kiyono, Masahiro; Fujii, Yosuke; Shiozaki, Yasuyuki; Sato, Ryozo
• Is Part Of: Trauma case reports. Volume 38(2022)
• Publication Date: 2022-04
• Subjects: Lower limb replantation -- Traumatic amputation -- Mangled extremity -- Limb salvage; Wounds and injuries -- Periodicals; Traumatology -- Periodicals; 617.1005
• DOI: 10.1016/j.tcr.2022.100631
• Languages: English
• ISSNs: 2352-6440

Abstract

Abstract: The absolute indications for lower limb replantation are not unequivocally established; rather, this procedure is still challenging and controversial. We report a case of a young male who underwent bilateral leg amputation, followed by unilateral replantation. The patient demonstrated good 10-year outcomes. A 23-year-old man had both of his lower legs crushed by heavy machinery that fell from the back of a truck, leading to amputation of bilateral lower limbs. Although bilateral amputation was recommended due to severe contusion on both sides, the patient and his family strongly requested replantation of the right leg, and surgery was started approximately 3 h after the injury. In addition to the emergency replantation, six surgeries were performed thereafter. Five months after the first surgery, the patient was fitted with a left lower leg prosthesis and started gait training. He was discharged 8 months later. Ten years after the replantation, the patient is satisfied with his leg. He has a normal gait with a prosthesis and has integrated into society with no functional deficit. There are still no clear standards for replantation after leg amputation, and individual decisions must be made based on the severity of the injury and the patient's general condition. In this case, we respected the patient's strong will to preserve the right leg and decided on the treatment plan. As a result, the patient was highly satisfied, and the spared right leg facilitated the patient's physical and mental recovery. Highlights: Lower limb replantation after amputation is challenging and controversial. We report unilateral replantation after bilateral amputation in a young male. Seven surgeries, including debridement and skin and nerve grafting, were required. The patient demonstrated good 10-year outcomes with no functional deficit. The spared right leg facilitated the patient's physical and mental recovery.