Wanjala NF, Michael A, Ominde KS, Reuben K, Gamal H. Re-implantation of foot and ankle following crush injury of the distal leg with 22 cm bone deficit: A case report.
Int J Surg Case Rep 2023;
105:108033. [PMID:
36989634 PMCID:
PMC10074562 DOI:
10.1016/j.ijscr.2023.108033]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION/IMPORTANCE
Crush injury with extensive soft tissue damage to an extremity is generally considered a contraindication to re-implantation and the extremity best managed by prosthesis. However good prosthesis is not easily available especially in resource constrained environment, the overall long term quality of life is also considered better with re-implantation.
CASE PRESENTATION
We report a 24 year old tourist patient who presented with post-traumatic amputation of the left leg following a road traffic accident. The patient had no other injuries. Clinical examination revealed extensive soft tissue damage to the involved leg. Radiograph done demonstrated segmental fracture of the distal tibia. The foot was successfully re-implanted after a lengthy surgery of 10 h. The patient was then subjected to an Illizarov bony lengthening procedure to correct the limb discrepancy length of about 20 cm.
CLINICAL DISCUSSION
Our patient through multidisciplinary approach and after a combination of many procedures had his foot salvaged with good functional outcome. Though the injury had both bony and soft tissue loss, limb shortening necessitated by the segmental fracture followed by Illizarov technique were able to ensure adequate length.
CONCLUSION
Post-traumatic crush amputation of the foot previously considered a contraindication for re-implantation could be salvaged by re-implantation in combination with bone lengthening procedure with good functional outcome.
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