title: Above-Knee Replantation Following Traumatic Bilateral Amputation: Sciatic Nerve Transplantation.
abstract: 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.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, University of Jena, Jena, Germany. Reinhard.Friedel@med.uni-jena.de.|Department of Trauma, Hand, and Reconstructive Surgery, Faculty of Medicine, University of Jena, Erlanger Allee 101, 07747, Jena, Germany. Reinhard.Friedel@med.uni-jena.de.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Friedel
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, University of Jena, Jena, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schmidt
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, University of Jena, Jena, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Dönicke
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, University of Jena, Jena, Germany.
authors.forename: Egbert
authors.initials: E
authors.lastname: Hüttemann
authors.affiliation: Grampian University NHS Trust, Orthopaedic Department, Aberdeen Royal Infirmary & Woodend Hospital, Scotland, UK.
authors.forename: Olaf
authors.initials: O
authors.lastname: Bach
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, University of Jena, Jena, Germany.|Department of Trauma and Reconstructive Surgery, Trauma Center Halle, Halle/Saale, Germany.
authors.forename: Gunther O
authors.initials: GO
authors.lastname: Hofmann
keywords: Reconstructive surgery