Bilateral lower leg replantation versus prosthetic replacement: long-term outcome of amputation after an occupational railroad accident.
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 long-term 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.
Schmidhammer
Robert
R
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology at the Research Center for Traumatology of AUVA, Vienna, Austria. r.schmidhammer@a1.net
Nimmervoll
Roman
R
Pelinka
Linda E
LE
Huber
Wolfgang
W
Schrei
Karl
K
Kroepfl
Albert
A
Redl
Heinz
H
D000203:Activities of Daily Living; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000601:surgery*; D001186:Artificial Limbs; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D017755:Prosthesis Fitting; D011788:Quality of Life; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome