Successful ankle replantation in two cases with different presentations

Abstract

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.

Initial Limb Salvage Intervention for a Mangled Lower Extremity in a Four-Year-Old Male: A Case Report of the Alternatives in Low-resource Settings

“…The arguments for completing the amputation included the securing of hemostasis in a shocked patient, conducting a shorter procedure, and eliminating the risk of crush syndrome or a reperfusion injury associated with limb salvage (9). The unavailability of vascular reconstruction (10) for such extremity injuries in most Ghanaian centers casts doubt about the future viability of a replanted mangled extremity, which was a valid consideration in our patient since the blood supply in the ankle area had less elaborate collaterals compared to the other large joints. The damage to the dorsalis pedis and the uncertain preservation of the posterior tibial artery further diminished the chances of extremity viability.…”

Surgical amputation of a limb 31,000 years ago in Borneo

“…With regard to TB1, we infer that the Late Pleistocene 'surgeon(s)' who amputated this individual's lower left leg must have possessed detailed knowledge of limb anatomy and muscular and vascular systems to prevent fatal blood loss and infection. They must also have understood the necessity to remove the limb for survival 29 . Finally, during surgery, the surrounding tissue including veins, vessels and nerves, were exposed and negotiated in such a way that allowed this individual to not only survive but also continue living with altered mobility.…”

“…Finally, during surgery, the surrounding tissue including veins, vessels and nerves, were exposed and negotiated in such a way that allowed this individual to not only survive but also continue living with altered mobility. Intensive post-operative nursing and care would have been vital, such as temperature regulation, regular feeding, bathing, and movement to prevent bed sores while the individual was immobile 29 . The wound would have been regularly cleaned, dressed, and disinfected, perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anaesthetics for pain relief 30,31 .…”