Successful Replantation of the Leg in a Pre-Ambulatory Infant

ABSTRACT

The authors report the first successful replantation of a below-knee amputation in a 7-month-old infant prior to the development of a standing and walking gait. Seven years following surgery, the child demonstrates excellent ankle and knee range of motion, has regained plantar sensation, and is able to walk, run, and jump without needing a brace. Despite a leg-length discrepancy of 5.5 cm, it is likely that future overgrowth of the injured limb will improve this discrepancy. This child has excellent potential for a successful functional outcome, given the very young age at the time of replantation and the plasticity of the central nervous system.

KEYWORDS

Amputation - leg-length discrepancy - infant replantation

REFERENCES

• 1 Magee H R, Parker W R. Replantation of the foot: results after two years.  Med J Aust. 1972;  1 751-755
• 2 Lesavoy M A. Successful replantation of lower leg and foot, with good sensibility and function.  Plast Reconstr Surg. 1979;  64 760-765
• 3 Tsai T M. Successful replantation of a forefoot.  Clin Orthop Relat Res. 1979;  139 182-184
• 4 Usui M, Minami M, Ishii S. Successful replantation of an amputated leg in a child.  Plast Reconstr Surg. 1979;  63 613-617
• 5 Jupiter J B, Tsai T M, Kleinert H E. Salvage replantation of lower limb amputations.  Plast Reconstr Surg. 1982;  69 1-8
• 6 Kutz J E, Jupiter J B, Tsai T M. Lower limb replantation: a report of nine cases.  Foot Ankle. 1983;  3 197-202
• 7 Kusunoki M, Toyoshima Y, Okajima M. Successful replantation of a leg-a 7-year follow-up.  Injury. 1984;  16 118-122
• 8 Vilkki S K. Replantation of a leg in an adult with 6-years follow-up.  Acta Orthop Scand. 1986;  57 447-449
• 9 Usui M, Kimura T, Yamazaki J. Replantation of the distal part of the leg.  J Bone Joint Surg. 1990;  72A 1370-1373
• 10 Yaffe B, Borenstein A, Seidman D, Amit Y. Successful replantation of both legs in a child-5-year follow-up: case report.  J Trauma. 1991;  31 264-267
• 11 Chiang Y C, Wei F C, Chen L M. Heel replantation and subsequent analysis of gait.  Plast Reconstr Surg. 1993;  91 729-732
• 12 Datiashvili R O. Simultaneous replantation of both lower legs in a child: a long-term result.  Plast Reconstr Surg. 1993;  91 541-547
• 13 Bajec J, Srakar F. Complete bilateral amputation of both legs in a 2-year-old child with 10 year follow up.  Injury. 1994;  25 255-258
• 14 Tukiainen E, Suominen E, Asko-Seljavaara S. Replantation, revascularization, and reconstruction of both legs after amputations: a case report.  J Bone Joint Surg. 1994;  76A 1712-1716
• 15 Masuda K, Usui M, Ishii S. A 17-year follow-up of replantation of a completely amputed leg in a child: case report.  J Reconstr Microsurg. 1995;  11 89-92
• 16 Pei G X, Kunde L, Chuwen C et al.. Replantation of four severed limbs in one patient.  Injury. 1997;  28 73-76
• 17 Park E H, Mackay D R, Manders E K, Segal L S. Replantation of the midfoot in a child-six-year follow-up with pedobarographic analysis.  J Reconstr Microsurg. 1999;  15 337-341
• 18 Malt R A, McKann C F. Replantation of several arms.  JAMA. 1964;  189 716-722
• 19 Mamakos M S. Lower extremity replant-a preliminary report.  Ann Plast Surg. 1980;  4 48-52
• 20 Demiri E, Bakhach J, Tsakoniatis N, Martin D, Baudet J. Bone growth after replantation in children.  J Reconstr Microsurg. 1995;  11 113-122
• 21 Clawson D K, Seddon H J. The late consequences of sciatic nerve injury.  J Bone Joint Surg. 1960;  42B 213-225
• 22 Birch R, Achan P. Peripheral nerve repairs and their results in children.  Hand Clin. 2000;  16 579-595