Lower limb replantation strategy after traumatic avulsion

Abstract

Background: 9 year old boy was admitted to Emergency Room due to traumatic amputation of his left leg. He experienced avulsion trauma after attempting to jump over tractor‘s cardan joint, his leg got stuck into it and was forcibly detached from the rest of the body. Lower part of the leg below the knee joint was completely avulsed from the rest of the body. Case: It was decided to replant the detached limb to salvage the knee joint which, if successful, would assure better outcomes for boy‘s future mobility. Replantation was needed to ensure revascularization of the knee joint. 14 days after the replantation, necrosis of the feet occurred, as expected, because of the severity of the trauma. Fortunately, knee joint revascularized and remained viable. Leg amputation inferior to the knee joint was performed by a plastic and reconstructive surgeon in assistance with orthopedic surgeon. Skin flap was used to form the stump. 2 months after the surgery leg stump healed completely, no necrosis or infection occurred. 6 months following the surgery, leg prosthesis was fitted. A year after the trauma boy is able to walk without crutches using calf prosthesis. Conclusions: Limb avulsion traumas are one of the most severe ones. Leg amputation is a life changing condition, especially for children. In this case the preservation of quality of life through regained function is crucial. The goal of replantation was to salvage the knee joint which is extremely important for leg mobility. Replantation allowed viability of the knee joint, which showed good outcomes after applying the prosthesis.