Journal
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE
Volume 57, Issue 4, Pages 824-831Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.TA.0000075521.52640.92
Keywords
replantation; amputation; prosthetic replacement; NISSSA
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Background: This retrospective study investigated three very similar cases of bilateral lower leg amputation. The aim was to determine which of two therapeutical procedures is associated with better longterm outcome: replantation or primary treatment of the stumps and subsequent prosthetic replacement. Methods: Evaluation included clinical examination, gait analysis, and a workup of the psychosocial background. Health problems were documented using the Nottingham Health Profile. Follow-up assessments were performed 6, 7, and 18 years after the trauma. Results: One patient underwent successful bilateral lower leg replantation and continued to work for the same employer. Two patients underwent prosthetic replacement. One became a social outcast confined to a wheelchair. The other patient had a good psychosocial background, similar to that of the patient who underwent replantation. He showed a better gait analysis on even ground than the replantation patient, but the findings were vice versa for uneven ground. Conclusions: The decision between replantation and prosthetic replacement after bilateral lower leg amputation is case related and cannot be generalized. Patients who have undergone these procedures require long-term psychological and physiotherapeutic care to achieve a good long-term surgical outcome.
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