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A case of forearm amputation with additional multilevel partial amputations

I Fogdestam, R Hamilton, G Lundborg

    Handchirurgie
    |January 1, 1981
    PubMed
    Summary
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    A severe pediatric forearm amputation was treated with a delayed reamputation and prosthesis. Despite initial replantation failure, extensive surgery enabled functional recovery and near-normal growth.

    Area of Science:

    • Orthopedic Surgery
    • Pediatric Trauma
    • Reconstructive Microsurgery

    Background:

    • A 4 1/2-year-old boy suffered a complex forearm amputation from a farm machinery accident.
    • The injury involved sharp amputation proximal to the wrist and deep incisions affecting bone, nerves, and soft tissues.

    Observation:

    • Initial replantation attempt failed after 19.5 hours, with a 16-hour cold anoxemia time.
    • The proximal amputated portion survived, necessitating a secondary reamputation at the radiocarpal joint level on day 21.
    • The stump was closed using viable skin from the dorsum of the hand.

    Findings:

    • One-year follow-up showed near-normal length growth in the affected forearm.
    • A myoelectric prosthesis demonstrated successful function, utilizing reinnervated extensor and denervated flexor muscles.

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  • The forearm achieved excellent revascularization and reinnervation despite the severe injury and multiple surgical interventions.

    • Implications:

    • This case highlights the potential for successful outcomes in complex pediatric extremity trauma through aggressive surgical management.
    • It underscores the importance of exploring all salvage options, even after initial replantation failure.
    • The successful use of a myoelectric prosthesis demonstrates the capacity for functional recovery in severely injured pediatric limbs.