Above-knee amputation followed by femoral replantation: 21-year follow-up results after lower limb replantation

Abstract

Above-knee amputation followed by femoral replantation:21-year follow-up results after lower limb replantation Literature on lower limb replantation continues to lack uniformity. Primary amputation is performed because of potentially life threatening postoperative complications and availability of technically refined lower limb orthoses, furthermore, safety and cost reduction are also taken into consideration.[1] After replantation at this level of the limb, when the decision was made based on several well known score systems, the replanted limb is usually amputated immediately after the appearance of the first symptoms of complications. [2][3][4] According to some authors, heterotopic replantation of the lower limb is indicated only in children [5,6] and in case of bilateral amputation. [7,8] In our case, we performed the replantation in 1986, when microsurgery was in a very early phase of development, furthermore, no score systems predicting the expected success of the replantation existed [such as Mangled Extremity Score (MESS), Limb Salvage Index (LSI), Predictive Salvage Index (PSI), Nerve injury-Ischemia-Soft tissue injurySkeletal injury-Shock-Age of patient (NISSSA), Hannover Fracture Scale (HFC)-97 version, Battiston ÖZ Bu yazıda, femurun orta üçte birinde travmatik ampütasyon sonrası ciddi replantasyon komplikasyonlarının başarılı tedavisi sunuldu. Bildiğimiz kadarıyla, literatürde benzeri bir olgu bildirilmemiştir. Otuz sekiz yaşında sağlıklı bir erkek sağ femurun orta üçte birinde travmatik ampütasyona maruz kaldı. Replantasyon uygulandı. Oligüri ve anüri gelişti ve hemofiltrasyon ve hemodiyaliz ile başarıyla tedavi edildi. Altı yıl sonra, hasta ortopedik ayakkabı giyerek yürüdü ve uzuvda koruyucu sensibilite düzeldi. Proksimal alt uzuv replantasyonunun ciddi komplikasyonları başarıyla tedavi edilebilir ve uzuv kurtarılabilir.Anahtar sözcükler: Ampütasyon; komplikasyonlar; alt ekstremite; replantasyon; travmatik. ABSTRACTIn this article, we report successful treatment of serious complications of replantation after traumatic mid-third femoral amputation. To the best of our knowledge, no similar case has been reported in the literature. A 38-year-old healthy male sustained a mid-third right traumatic femoral amputation. We performed replantation. Oliguria and anuria occurred and were treated successfully with hemofiltration and hemodialysis. Six years later, patient walked wearing orthopedic shoes and also protective sensibility recovered on the limb. Serious complications of proximal lower limb replantation can be treated successfully and the limb is saveable.