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Perinatal limb ischemia: orthopaedic implications
J E Blank1, J P Dormans, R S Davidson
1Department of Pediatric Orthopaedics, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA.
Insights
Perinatal limb ischemia often requires amputation in infants. However, many children treated for this condition achieve good function with prostheses, demonstrating positive long-term outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Vascular Surgery
Background:
- Perinatal limb ischemia is a serious condition affecting newborns.
- It can lead to the need for amputation, impacting long-term function.
- Understanding causes and outcomes is crucial for pediatric care.
Purpose of the Study:
- To review the causes and treatment outcomes of perinatal limb ischemia requiring amputation.
- To assess the functional results in patients treated for this condition.
- To evaluate the efficacy of interventions and long-term prosthetic use.
Main Methods:
- Retrospective review of 15 patients with perinatal limb ischemia requiring amputation.
- Analysis of causes including arterial thrombosis, thromboembolism, and intravenous infiltrate.
- Evaluation of amputation timing, follow-up duration, and prosthetic use.
Main Results:
- Common causes included arterial catheterization complications and hypercoagulable states.
- Amputation was performed on average at 8.5 weeks postnatal age.
- Of 11 followed patients, 9 achieved good function with prostheses.
Conclusions:
- Perinatal limb ischemia necessitating amputation can have varied causes.
- Despite amputation, many children achieve good functional outcomes with prostheses.
- Early intervention and prosthetic fitting are key to long-term rehabilitation.
Abstract:
Fifteen patients (16 ischemic limbs) who ultimately required amputation for perinatal limb ischemia were treated at The Children's Hospital of Philadelphia and the Shriners Hospital for Crippled Children in Philadelphia between 1980 and 1993. The average birth weight of these patients was 1,870 g, and the average gestational age was 30.8 weeks. Ischemic events occurred at an average postnatal age of 5.4 weeks. The causes of the ischemia included (a) arterial thrombosis as a complication of arterial catheterization (eight patients), (b) thromboembolism resulting from a hypercoagulable state (five patients), (c) intravenous infiltrate (one patient), and (d) in utero arterial thrombosis (one patient). Amputation was required at an average postnatal age of 8.5 weeks. The final patient, with concurrent ischemia involving the right hand and left leg, had complete resolution of the ischemic hand with fibrinolytic therapy alone and required only an amputation of the lower extremity. Eleven of the 15 patients were available for follow-up (two dead, two lost to follow-up), at an average of 4.5 years. Nine of these 11 patients (six lower and three upper extremities) are functioning well in prostheses. The two remaining patients are infants who will be fitted for lower-extremity prostheses when they begin to attempt to walk.