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Above-the-knee replantation in a child: a case report with a 24-year follow-up.

Durban CM, Lee SY, Lim HC - Strategies Trauma Limb Reconstr (2015)

Bottom Line: Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation.Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure.However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Republic of Korea.

ABSTRACT
Replantation of an amputated limb is generally contraindicated in crushing and traction injuries. Injury to muscle tissue and skin also creates difficulties in coverage, and bony fractures may shorten limb length which can impede lower extremity function. Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation. We report a case of successful thigh-level replantation in a 3-year-old child who sustained a crushing-traction type of injury with a follow-up of 24 years. After the replantation, early and late complications developed but these were successfully managed. On her last visit, the patient had pain-free ambulation without assistance, had intact protective sensation distal to the injury, and was very satisfied with the outcome. Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure. However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.

No MeSH data available.


Related in: MedlinePlus

Serial follow-up beginning 4 years (a), 6 years (b), and 8 years (c) after surgery demonstrating worsening knee and ankle contractures
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Fig3: Serial follow-up beginning 4 years (a), 6 years (b), and 8 years (c) after surgery demonstrating worsening knee and ankle contractures

Mentions: At 4 years after the injury, the patient was ambulatory without assistance and no leg length discrepancy was noted at the time; knee flexion was noted at more than 90° and ankle dorsiflexion was to 10°. Six years after injury, the patient was able to stand on the affected limb without support, but soft tissue contractures had developed in the ankle and knee joints. No intervention was done at this time. When patient was 11 years old, 8 years after the injury, the knee flexion contracture was severe and a Z-plasty of the popliteal area to release the scar tissue contracture (Fig. 3) was carried out. With continued rehabilitation, the patient was able to regain full knee extension though flexion was limited to 90°. She was ambulatory without support but left with an equinus deformity of the left ankle. The leg length discrepancy had become more pronounced at this time of a growth spurt. She underwent her last major surgery when she was 12 years old; a femoral osteotomy was done, and an external fixator was applied for gradual lengthening to correct the 6-cm shortening of the left lower extremity.Fig. 3


Above-the-knee replantation in a child: a case report with a 24-year follow-up.

Durban CM, Lee SY, Lim HC - Strategies Trauma Limb Reconstr (2015)

Serial follow-up beginning 4 years (a), 6 years (b), and 8 years (c) after surgery demonstrating worsening knee and ankle contractures
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666230&req=5

Fig3: Serial follow-up beginning 4 years (a), 6 years (b), and 8 years (c) after surgery demonstrating worsening knee and ankle contractures
Mentions: At 4 years after the injury, the patient was ambulatory without assistance and no leg length discrepancy was noted at the time; knee flexion was noted at more than 90° and ankle dorsiflexion was to 10°. Six years after injury, the patient was able to stand on the affected limb without support, but soft tissue contractures had developed in the ankle and knee joints. No intervention was done at this time. When patient was 11 years old, 8 years after the injury, the knee flexion contracture was severe and a Z-plasty of the popliteal area to release the scar tissue contracture (Fig. 3) was carried out. With continued rehabilitation, the patient was able to regain full knee extension though flexion was limited to 90°. She was ambulatory without support but left with an equinus deformity of the left ankle. The leg length discrepancy had become more pronounced at this time of a growth spurt. She underwent her last major surgery when she was 12 years old; a femoral osteotomy was done, and an external fixator was applied for gradual lengthening to correct the 6-cm shortening of the left lower extremity.Fig. 3

Bottom Line: Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation.Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure.However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Republic of Korea.

ABSTRACT
Replantation of an amputated limb is generally contraindicated in crushing and traction injuries. Injury to muscle tissue and skin also creates difficulties in coverage, and bony fractures may shorten limb length which can impede lower extremity function. Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation. We report a case of successful thigh-level replantation in a 3-year-old child who sustained a crushing-traction type of injury with a follow-up of 24 years. After the replantation, early and late complications developed but these were successfully managed. On her last visit, the patient had pain-free ambulation without assistance, had intact protective sensation distal to the injury, and was very satisfied with the outcome. Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure. However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.

No MeSH data available.


Related in: MedlinePlus