Rehabilitation in a patient with replantation of amputated distal leg

Abstract

Background: Many studies have been reported on replantation of an upper extremity after traumatic amputation, but there are only a few case reports on replantation of the lower extremities rather than amputation surgery. This is due to preoperative factors, complications and the possibility of good prosthetic substitution.We describe here the dynamic evaluation necessary for a continuous rehabilitation treatment in a subject with replanted left foot after traumatic amputation.

Case report: A 58-year-old male person with amputation of the left leg at the level of the left talocrural joint, with talar dome and bimalleolar fractures and complete section of the blood vessels, nerves and tendons was considered for replantation surgery 7 hours after a traumatic injury.For an accurate evaluation of the postoperative conditions over time, clinical functional assessment combined with imaging and neurophysiological examination were conducted.Rehabilitation program is aimed to train the motor and sensory function of the replanted foot and to prevent undesired biomechanical changes that limit person's ability to perform everyday tasks. During the rehabilitation program there were a progressive recovery of the patient's protective sensation, active motion angles of the left ankle joint and muscle power of the replanted leg. Those are sufficient for walking activity and help the patient considerably in performing his everyday minimal housework.

Conclusions: A well designed postoperative dynamic rehabilitation program is necessary in order to regain functionality after successful distal leg replantation surgery. The clinical and imaging evaluation support a dynamic rehabilitation program adapted to different stages of functional recovery.

Keywords: leg replantation; musculoskeletal ultrasound; rehabilitation.

Figure 1. Amputated left leg before and after replantation surgery

Figure 1. Amputated left leg before and after replantation surgery

Figure 2. Left leg - on initial physical examination, before the rehabilitation treatment

Figure 2. Left leg - on initial physical examination, before the rehabilitation treatment

Figure 2. Left leg - on initial physical examination, before the rehabilitation treatment

Figure 3. Anterior ankle – ultrasound evaluation

Figure 3. Anterior ankle – ultrasound evaluation

Figure 3. Anterior ankle – ultrasound evaluation

Figure 3. Anterior ankle – ultrasound evaluation

Figure 4. Posterior ankle - ultrasound evaluation

Figure 4. Posterior ankle - ultrasound evaluation

Figure 4. Posterior ankle - ultrasound evaluation

Figure 5. Posteromedial ankle - ultrasound evaluation

Figure 6. Posteromedial ankle – ultrasound evaluation of the tibial nerve

Figure 6. Posteromedial ankle – ultrasound evaluation of the tibial nerve

Figure 7. Lateral and antero-posterior plain film of the left ankle

Figure 8. EMG examination of left foot - flexor hallucis brevis and extensor digitorum brevis, 4 months after replantation surgery

Figure 8. EMG examination of left foot - flexor hallucis brevis and extensor digitorum brevis, 4 months after replantation surgery

Figure 9. Sympathetic skin response test, 4 months after replantation surgery

Figure 9. Sympathetic skin response test, 4 months after replantation surgery