Friedel Reinhard, Schmidt Ralf, Dönicke Torsten, Hüttemann Egbert, Bach Olaf, Hofmann Gunther O
Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, University of Jena, Jena, Germany.
Department of Trauma, Hand, and Reconstructive Surgery, Faculty of Medicine, University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
Eur J Trauma Emerg Surg. 2007 Apr;33(2):192-7. doi: 10.1007/s00068-006-6008-2. Epub 2007 Apr 4.
A 12-year-old boy who was overrun by a train, sustained traumatic bilateral above-knee amputation and a rupture of the symphysis. The left leg had multiple fractures and soft tissue injuries and amputation was necessary. The right one, although severely crushed, at the amputation site and with a MESS of 9, was replanted accepting some shortening and a soft tissue defect at the amputation site, employing saphenic vein grafts from the amputate (left leg) and an early free latissimus dorsi-flap. Septic complications at the amputation site were managed, and an autologous sciatic nerve graft was performed 8 months after the accident, employing the contralateral above-knee stump as the donor. Protective foot sole sensitivity was noticed after 2 years and 4 months and continued to improve. Further reconstructive procedures included ORIF of a femoral fracture in the contra-lateral stump. On the replanted leg proximal tibia corrective osteotomy and lateral collateral knee ligament reconstruction were performed. A follow-up of 7 years and 9 months demonstrates now a leg capable of full weight bearing and recovery of overall protective sensitivity. The boy made good psycho-social progress after difficulties and feels that the replanted leg is of significantly greater use to him than the hi-tech prosthesis on the other leg.
