Revascularization and Reconstruction of a Near Total Amputation of Foot

Vol. 10 | Issue 2 | August-September 2022 | Page: 44-47 | Latheesh Leo , Akhil X. Joseph


Authors: Latheesh Leo [1], Akhil X. Joseph [1]

[1] Department of Orthopaedic Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India.

Address of Correspondence

Dr. Akhil X. Joseph,
Department of Orthopaedic Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India.


Case: A 23-year-old male presented with a history of Road traffic accident, 8 hours post injury. He was diagnosed to have a Type 3C open fracture with near total amputation at the level of distal third of leg (MESS score 10). He underwent tendon repair, neurovascular repair and ex-fix application. On post-op day 5 he developed skin necrosis and underwent an Anterolateral flow-through free flap. 2 months later, after a complete soft tissue recovery, a limb reconstruction system was applied and proximal corticotomy was done, with regular distraction at 1mm/day until limb length was achieved. 11 months post injury he made a complete bony and soft tissue recovery.
Conclusion: Traumatic amputations are more common among the younger population as it is a result of high velocity road traffic accidents. An amputated limb not only physically impairs a patient but is also a psychological hurdle to overcome. Despite a MESS score of 10, in our case study we managed to salvage a foot, that had undergone near total amputation, 8 hours post injury, with a complete soft tissue and bony recovery. With improved survival and functional outcomes of replanted limbs, replantation should be a high priority as opposed to primary amputation in cases of total or subtotal lower extremity amputations.
Keywords: Near Total Amputation Foot, Revascularisation, Reconstruction, Limb Lengthening, Alt Free Fap


1. Bondurant FJ, Colter HB, Buckle R, Miller-Crotchett P, Browner BD. The medical and economic impact of severely injured lower extremities. J Trauma 1988;28:1270–1273.
2. Helfert DL, Howy T, Sanders R, Johansen K. Limb salvage versus amputation. Clin Orthop Relat Res. 1990;256:80– 86.
3. Hansen ST Jr. Overview of the severely traumatized lower limb reconstruction versus amputation. Clin Orthop Relat Res. 1989;243:17–19.
4. Gayle LB, Lineaweaver WC, Buncke GM, et al. Lower extremity replantation. Clin Plast Surg. 1991;18:437–447.
5. Magee, H. R., and Parker, W. R., Medical J7ournal of Australia, 1972, 1, 751.
6. Robertson PA. Prediction of amputation after severe lower limb trauma. J Bone Joint Surg (Br.) 1991;73:816–818.
7. Cavadas PC, Landin L, Iban˜ez J. Temporary catheter perfusion and artery: Last sequence of repair in macro-replantations. J Plast Reconstr Aesthet Surg. (in press)
8. Cavadas PC, Landin L, Ibanez J, et al. Infrapopliteal lower extremity replantation. Plast Reconstr Surg. 2009;124:532–9.
9. Cavadas PC, Thione A. Lower limb replantation. In: Salyapongse AN, Poore S, Afifi A, et al., editors. Extremity replantation: a comprehensive clinical guide. New York: Springer; 2015. pp. 145–59.
10. Bosse MJ, McCarthy ML, Jones AL, et al. The insensate foot following severe lower extremity trauma: an indication for amputation? J Bone Joint Surg Am. 2005;87:2601–8.
11. Kutz JE, Jupiter JB, Tsai TM. Lower limb replantation: a report of nine cases. Foot Ankle. 1983;3:197–202.
12. Battiston B, Tos P, Pontini I, et al. Lower limb replantations: indications and a new scoring system. Microsurgery. 2002;22:187–92.
13. Hierner R, Betz A, Pohlemann T, et al. Long-term results after lower-leg replantation. Eur J Trauma. 2005;31:389–97.

How to Cite this article: Leo L, Joseph AX | Revascularization and Reconstruction of a Near Total Amputation of Foot | August-September 2022; 10(2): 44-47.


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