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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

On last visit, knee flexion was 90° (a), extension was full (b, c); patient ambulated with an equinus deformity (d, e)
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Fig4: On last visit, knee flexion was 90° (a), extension was full (b, c); patient ambulated with an equinus deformity (d, e)

Mentions: At the last review in September 2009, the patient was 25 years old. At 21 years after the incident, she remained freely ambulatory but with an equinus deformity of the left ankle. The knee range of motion was maintained at 0–90 degrees of flexion, the foot was sensate, and she was also able to move her toes (Fig. 4). Radiographs taken showed left lower extremity was shorter but the fractures and osteotomy sites had completely remodeled (Fig. 5). In 2012 through a telephone interview, the patient described her knee movement as unchanged and had no new complaints. She was satisfied with the functional outcome of her left lower limb despite it not being esthetically pleasing. Aside from the operative scars from the skin grafts, the limb was thinner from severe reduction in muscle bulk over the leg where debridement had been done. The patient was content that she was walking with her own limb with intact sensation and had avoided a prosthesis.Fig. 4


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)

On last visit, knee flexion was 90° (a), extension was full (b, c); patient ambulated with an equinus deformity (d, e)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: On last visit, knee flexion was 90° (a), extension was full (b, c); patient ambulated with an equinus deformity (d, e)
Mentions: At the last review in September 2009, the patient was 25 years old. At 21 years after the incident, she remained freely ambulatory but with an equinus deformity of the left ankle. The knee range of motion was maintained at 0–90 degrees of flexion, the foot was sensate, and she was also able to move her toes (Fig. 4). Radiographs taken showed left lower extremity was shorter but the fractures and osteotomy sites had completely remodeled (Fig. 5). In 2012 through a telephone interview, the patient described her knee movement as unchanged and had no new complaints. She was satisfied with the functional outcome of her left lower limb despite it not being esthetically pleasing. Aside from the operative scars from the skin grafts, the limb was thinner from severe reduction in muscle bulk over the leg where debridement had been done. The patient was content that she was walking with her own limb with intact sensation and had avoided a prosthesis.Fig. 4

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